65041D - Rice

7/16/2015 Morgan or Erica Mehler
7/17/2015 7/20/15 Stanley or Sharon Stubbs
7/17/201 77/20/15 Richard or Sharon Love
7/17/2015 7/20/15 Antinoti Construction, Inc.
7/17/2015 7/2 //15 Holden Dock & Bulkheads
7/17/2615, 7/20/15 Atlantic Coast Industrial LL
7/20/2015 Money order from Brandon
7/20/2015 Robert or Candace Rice
ind Shores HOA
Park Sterling Bank
1017
$100.00 renewal fee, MP 1,
B of
4859
$200.00 GP for 1304 Caroli
_
Wells Fargo Bank
1434
$200.00 GP 64712D
Mohr
B of
3780
$200.00 GP 64715D
Odam & Rufus Yates
CresCom Bank
2181
$200.00 GP 64697D
Brinkley
BB &T
11791
$200,00 GP 1400 Point Hai
is Welfare
Wells Fargo Bank
17-213876532
$200.00 GP 64717D
BB &T
10394
$200.00 GP 65041D

KC Division of Coastai Mgt. Habitat Impact Computer Sheet
Applicant: j)1' fiV� �'1 /r Permit
t�
Date:
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 impacts)
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
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 El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i4 C t, 's
pp (Name of Property Owner)
property located at _ b 11 l �� "� 11 es 1� r.�-ol
(Address, Lot, Block, Road, etc.)
on �u►�Yt CYt c /c , in IIG, 0-'-0 c N.C.
(Waterbody) (City/Town and/or County)
The1 applicant 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope y Owner Information) (A cent Prope Owner Information)
Sign urSin tore /
Pr t or T ame
G - yp/ y � J .) / Pn t or Typ ame
M1 Address- 7S / b� i12 Ad re
2�Y�f3d�, ��

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to A 5fp� s t!C� v►�C e i C C 's
property located at _ 6 G ! f is (4 P f (Name of Property Owner)
C
(Address, Lot, pippck, Road tc.)
on orn c C' rep /C in yG Q <✓
N.C.
(Waterbody)
(City/Town and/or County)
The applicant 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop y Owner Inf rmation)
Sl �11 e /J
KG
Prrn or T e me
Mali Addre
ILA
(Adjacent Property Ow forma
Si e
Print o T "e e
6
Main Address ��

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