64723D - Lee

Date I Deposi
Received I
tied I
Check From Name
Name of Permit Holder
4/16/2015
4.23.15
4.23.15
4.23.15
Archie McGirt and Janet Batten
Mellinee and John Hunt
R. Burak Erem
same
same
same
same
King
same
Thompson
Tatum
4/16/2015
4/20/2015
4/20/2015
4.23.15
Charles D. Carmen Jr.
4/20/2015
4.23.15
Southeastern Coastal Construction Co.
4/20/2015
4.23.15
Charles Douglas Wilson or Carolyn Wilson
4/20/2015
4.23.15
Maritime Coastal Construction LLC
4/21/2015
4.23.15
Coastal Marine Piers Bulkheads LLC
4/17/2015
4.23.15
Allied Marine Contractors, LLC
McLeod
4/24/2015
Backwater Mari
Clements Marin
F and S Marine
Thomas Power Systems, Inc.
Custom Island Homes by Ken Kisler LLC_
Money order for Brandon Grimes
Money order for Brandon Grimes
Kimley-Horn & Assoc., Inc.
Porters Neck Homeowners Assoc., Inc
VCC, Inc.
27.15
Irvin Ray McDonald, Jr.
27.15
Clements Marine Construction
etn LeMoine or Louis LeMoine
Quartermaster Store @Marker 90
1.15
Coastal Marine Piers Bulkheads LLC
1.15
O'Quin Construction
1.15
Money order for Brandon Grimes
1.15
Money order for Brandon Grimes
1.15
James W. Jones Jr. and Donna Jones
Jam Properties/Dan Smith transferred fin
Williams
Town of Holden Beach
James and Jane Warren
Mable Buchanan
Elliott W. and Francis H. Shaver
_ Judy H. and Paul C. Starks, Jr.
Thomas Besedin
William Critcher
Donald Howell
Michael Kurich
City of Wilmington -Heide Trask Bridge \
same
Altamar Inc.
508 Tradewind appl.
110 Sanford Street
_ same
Anthony Jeffs
same
R. Baxley
Paul Sommers
Robert and Rhea Allison
Kevin Post
Kevin Post
v
Vendor
First Citizens Bank
NC State Employees' Credit U
BofA
Piedmont Advantage Credit Ui
First Federal
TD Bank
CresCom Bank
Wells Fargo Bank
BofA
Marine Federal Credit Union
BB &T
First Citizens Bank
Lucien Ellison 1
_ BofA
CresCom Bank
Wells Fargo Bank
Wells Fargo Bank
ilkway Wells Fargo Bank
North State Bank
PNC Bank
South State Bank
- BB &T
Charles Schwab Bank
First Citizens Bank
B of A
TD Bank
Wells Fargo Bank
First Citizens Bank_
North Amer. Banking Co
North Amer. Banking Co
Check Check
Number amount I Permit Numb.
10291 $200.001GP 65197D
7363
$250.00 'major fee, TO, F
185
$200.00 GP 65170D
1889
$200.00 GP 54601D
3779
$300.00 GP 64612D (�$
MP 65-0 renem
4450
$400.00
1 GP 64611 D
GP 65191 D @$
GP 65192D @$
GP 65193D @$
3426
$200.00 NOV 15-06D
3317
$200.00 GP 6206 E. Yac
182261643
$300.00 GP 65182D @$
182261642
$500,00 GP 65183D �$
2159574
$400,00 major fee, NHG
394
$400.00 major fee, NHC1
26651
$100.00 mod fee, 46-92
1517
$100.00 minor fee, Nayk
3372
$200.00 ? _--
101 tl
$200.00 GP for 996 Gay
3767�
$250.00
major fee, PING
115
$100.00
minor fee, NTB,
917
$400.00
major fee, 579 l
20169
$200.00
GP 64613D
- 8049
$100.00
minor fee,6083
347408688
$100.00
GP 65171D @3
347408687
$500.00
GP 65171D @3
1702
$200.60
GP 812for Simi

NC-Divislon of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date:
7 la �f�
Permit* (9y f'�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
found in your Habitat code sheet.
Habitat Name
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
Choose One includes any
anticipated
restoration or
temp im ac
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp .
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
I temp impacts)
FINAL feet
(Anticipated fi
disturbance.
Excludes any
restoration an,
temp impact
amount)
Dredge [I Fill El Both ❑ Other
��9
a
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 [I Fill ❑ Both �] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
it McCrory Donald R. van der
;ovemor
Secretary
AGENT AUTHORIZATION FORM
of Property Ow er Applying for Permit:
ner's Mailing Address:
�6��/5s7�trl N
\_
/_sir_-I�L_l. Ate' �L
•V
ne l 7
me of Authorized AgeTA
for this project:
AA A L_
Agent's Mailing Address:
e
Email:
Phone
rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all Permits necessary to install or construct tF� folloying (activity):
1 . . . n
%ect Site Address:
Property Owner Signature Date*
*This narfifinnfinn is iinlirJ 4 vonr frnm r -1^ L,....r. -^.4.. ..,.

M ►si
1 i H Sq-OD5
S�Q4S rZ, X_Z
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0

• t � � CA
2�
n
3
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i
i
I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LL E Lk2e s
(N/ame of Proper
property located at 2 �( (�/) 4/ d'1U
(Address, Lot,,B_lgcl ,, Road, t .)
on w ' in V" f (_ , C N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
if)
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)
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.
v I do not wish to waive the 15' setback requirement.
(Adjoccent Property Owner Information)
'Si at r
�'N I
Print or T pe N e
I7 it4m,

ADJACENT
E
I hereby certify that I own adjacent to -�. s
Name of P p Owner)
property located at 2 l � SI A4 ko ml y
i l i (Address, Lpt, Block, Road, tc�
on �tJ in /��) z / � N.C.
(Waterbody) (City/Town and/or County)
tapplicant has described to me, as shown below, the development proposed at the above location.
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)
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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(P p rty Owner Inf rmation) (Adjace Propert Owner Information)
Sign use Signature
Print or Type Name ,, /� Print or Type Ne