65037D - Ledoux

Date
Received
Check From (Name)
Name of Permit Holder
Vendor
Check
Number
Check
amount
Permit Number/C
3/2/2015 Pacula Builders LLC Roy Gilbert & Brenda Madison First Citizens Bank
3/2/2015 Pacula Builder_s_LLC Dennis Michael Security_ Savings Bank
Dennis Michael
3/2/2015 David Lee Builders, Inc Edwards B of A
3/3/2015 Carolina Marine Construction, Inc. John Clark_ First Bank
3/3l2015 East Coast Engineering &Surveying, P.C. Dint ah Gore First Bank
3/4/2015 Hunter Development Corp. John Ledoux Yadkin Bank
_v
p >
Ln p U v i
L C
=_ O
i _
1138
1847
19918
9496
1308
22714
$600.00
$400.00
GP 65079D
GP 65102D @$200
GP 65103D @$200
$100.00
minor fee, T_B_15_-M
$400.00
GP 65093D
$100.00
$200.00
minor fee, SB 15-0'
GP 65037D

iC Division of Coastal Mgt. Habitat Impact Computer Sheet
j Permit #:
,J
.pplicant: D
)ate: 3 / S�
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in vour Habitat code sheet.
TOTAI
(APp
DISTURB
TYPE
Disturb.
labitat Name
Choose One
inclu(
antic
restoi
temp
Dredge ❑
Fill ❑
Both ❑
Other
Dredge ❑
Dredge ❑
Fill ❑
Fill ❑
Both ❑
Both ❑
Other ❑
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 Q
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other 171
Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
.
ied for.
(Anticipated final
(Applied for.
(Anticipated final
ince total
disturbance.
Disturbance
disturbance.
les any
Excludes any
total includes
any anticipated .
Excludes any
restoration and/or
ipated
ation or
restoration
and/or temp
restoration or
temp impact
7 �; -/ 1 S�

N.C. DIVISION OF COASTAL. MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit;-
�a
Mailing Address:JA
-
Y certify that I have authorized (agent) _ c��e VA urA lk to soon my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or vonitruct (activity) `JJ C-
at (my properly located at)
This certification is valid thru (date)
v,
Property
Date

kv
...+ ... ... �� mat i awn war ar►t to n h N tie.V D u_ x 'S
>�Y �� N a-�• (�
_...... _.._ . R ► I ,., _Ud if,t,ot, Bfo`a`.� '�tc.�t its.' N.C. 1
The appflcant has desGnbed to me as shovm below, the daM�bpr�'+s dt mp d` � i-�r-�;-•
i li:' .
I have no 6b}ochohit6this'proporal. 4
I hen ob*MGM W Oft propOW-
` �---- f1� rtfV �at� �y� ,�y�yy _
! MBCRtp'T N AMCW DMV111 G CF- PROPO>3l:D �7 VELO O ` i r.
***WtpW-=tM i1 "MW oriel a SW d
r.
WANM W lION
I under'atend that a pla, dodo. mmkV pMfngs, bout romp, breaWater, t"house. fift, or groin
must be at back a MMWM distance of 15' *Om my area of dparlen B=m unless waved by
�y me. (if you wish to waive the seftO, YOU must it W the ate btank below.)
I do wish to waive the 1 a' Setback tequimlent.,
I do not wish to waive the 15' eetbadc requirement.
kft matton) OdWAM Prop Owruer bft"MMM)
R S4
t4 UN
rd or
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