69344D - Puckett

7/26/2017
Hazel Carol Larson
Peter Larson
BB&T
13389
$100.00 renewal fee, MP 58-09
7/27/2017
Grice Construction
P.H. McKinney
BB&T
11381
$200.00 GP 69336
7/27/2017
Tommy or Billie Puckett
same
BB&T
1011
$200.00 GP 69344D
7/27/2017
Grice Construction
Jonathan Earl Bowling
BB&T
11369
$200.00 GP 69339D
7/27/2017
Grice Construction
Julia Harris
BB&T
11386
$200.00 GP 69335D
7/27/2017
Town of Carolina Beach
same
BB&T
70056
$200.00 GP 69349D
7/27/2017
Sisters Investments LLC
same
Yadkin Bank
1127
$400.00 GP 69210D
7/27/2017
Lighthouse Marine Construction
James Mulligan
Coastal Bank & Trust
1581
$200.00 GP 69302D
7/27/2017
Lighthouse Marine Construction
Charli Davis
Coastal Bank & Trust
1582
$200.00 GP 69300D
7/27/2017,
Carolina Bluewater Construction
same
BB&T
17980
$200.00,GP 69345D
7/27/2017
Southeastern Coastal Construction Co.
Becky Hucks
South State
10397
$200.00 GP 69291 D
7/27/2017
Lighthouse Marine Construction
Betty Westbrook
Coastal Bank & Trust
1580
$600.00I GP 69301 D
7/28/2017
Frank Williams Building Co
Frank Williams
First Bank
3685
$100.00 minor fee, Lot 2 Washington Acn
7/31/2017
Cary or Brandi Kerns
Vivian & Karen Osborne
ElecTel Coop. Federal (
1305
$548.00 NOV 17-12D. BrCo

NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: TooA r 1 Fu c yt Permit #:
Date:
v/11
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied. for.
Disturbance total
includes any
anticipated
restoration or
temp im acts
FINAL Sq. Ft.
(Anticipated final
disturbance.
Exdudes any
restoration
and/or temp .
impact amount
TOTAL Feet.
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
`
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge [❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: V '
Phone Number:
Email Address:
I certify that I have authorized
, 'Zj-. „ , - „.
to act on my behalf, for the purpose of applying for and obtaining /all CAAMA permits
necessary for the following proposed development:
at my property located at lS U
in rc w County.
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Pr' t or Type Name
0tt)A'tC_
Title
In .0 - -

I hereby certify that I own property adjacent to
property located at
on , (Address, Lot,
, in
(Waterbody)
Lai,1
VeF s
Owner)
County)
The applicant has described to me, as shown below, the development proposed at the above location.
y I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
6-
t-P P16 �Jq
t
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
t
6 5 L
ierty r In ation)
/D S
ne

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. V0 67-) S
Address of Property: C---C) % 7 C P 'Lp0 L- 5��� �
(Lot or Street #Street or Road, Co & County)
Agent's Name #: ✓; V/:, 61L.1-11S Mailing Address:
Agent's phone # �_ �(,� a�_ OCc Oy -:�- s Le
e
,;?
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
L/ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (if you
wish to waive the setback, you must initial the appropriate blank below.)
'_- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
( rope rty Owner nformation)
Signature
7,,,7,ov zv4x,�, ze
not or Tyo Name
%4 qe) &e/q-,() , F �2, 51")
(Adj cent ro rty Ow Info on)
/V,/
Si ature
4 / -i
T-rini or Type Name
h9y5 z-es �ele s
Mailing Address
/I / -? . t ,
Mailing Address
t i /-. I..

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to d� fil
�
/ (Name of Property wner)
Property located at (,; j Cp/, �; �/� , •„ ;,
on C �/
(Waterbody)
(Address, Lot, Block, Road, etc.)
in
(City/Town and/or County)
N.(
The applicant has described to me, as shown below, the development proposed at the above I
I have no objection to this proposal.
I have objections to this proposal.
ULSCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drat
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be se
minimum distance of 15' from my area of riparian access unless waived by me. (if you wish i
the tback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(P�64erl:VO)gner loormgion)
Sig�{a ure
N L-L" )J `-1
Print or Type Name
r Information)
Signature j)
�o M T D.
Print orrType Name r