65040D - Rose

LAMA / ❑ DREDGE & FILL
iENEPAL PERMIT
New ❑Modification El Complete Reissue
Partial Reissue
Previous permit #
Date previous permit issued
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zed by the State of North Carolina, Department of Environment and Natural Resources u
instal Resources Commission in an area of environmental concern pursuant to I SA NCAC ' + te'o
❑ Rules attached.
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6/1i3/Zu10
1 6/z I/1 D
wime Clarence Klcnaroson
deny ana uSa SroKa
BB &T
6036 $400.00
GP 64678D @;
Michael Gerke
GP 64639D
6/22/2015
6/22/2015'
6/22/2015
6/22/2015
6/23/15
Clements Marine Construction
Radiant Investment Inc.
Dennis or Beverly Morgan
East Coast Engineering & Surveying, P.C.
Smith
First Citizens Bank
3826 $1,200.00
_ -_
_ _
4380 $100.00
5001 $200.00
1419 $100.00
GP 64679D @:
6/23/15
6/23/15
6/23/15
Smith
GP 64680D
Harry L. Kraly
Crescent State Bank
renewal fee, MI
GP for 124 Chi
minor fee, 4911
same
High Point Bank and Trust
Alan & Tambra Lewis
First Bank
6/22/2015
6/23/15
VR Properties, LLC
Robert Huckabee
NewBridge Bank
542
$600.00
GP 64675D
Robert Huckabee
GP 64676D
6/22/2016
6/23/15
Money order for Brandon Grimes
Jarrell & Patricia Brown
Wells Fargo Bank
59147268345
$200.00
GP 64703D
6/23/2015
Lighthouse Marine Construction Inc
Joe Mark Rose
S of A
5430
$200.00
GP 65040D

He Division of Coastal Mgt. Habitat impact Computer Sheet
/ �� /� °sue Permit*
� �O �o
Applicant: J
Date: ! 7,15 — S�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
for.
FINAL Feet
(Anticipated final
(Applied for.
Disturbance total
(Anticipated final
disturbance.
(Applied
Disturbance
disturbance.
Habitat Name
DISTURB TYPE
Choose One
includes any
Excludes any
restoration
total includes
any anticipated .
Excludes any
restoration and/or
anticipated
restoration or
and/or temp
restoration or
temp impact
Dredge ❑ Filp 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 ❑ Bath ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Sot- May 1I'� P"o S -ems 's
1 (Name of Property Owner)
property located at 6 t t Gr
i sdl (Addre, Lot, Block, R(oa tc.)
on �i S C,�G��.. in c,W%LcaI N.C.
(W aterbody) City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiop.
�i� p 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, boat ramp, 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.)
volPo I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Inform . n)
Signatu e �n `R—
O
Print or Type Name
\3 yL7)
Mailing Address
(Adjacent Property Owner Information)
Q De /
Mgnature *
So5e-PA LvAU gel+sie y
Print or T pe Name
0 Awe
Mailina Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ':�d e— 1)\C,-yk (n;<, -Q-- s
1
property located at � �� �cy\ o .1 c (Name of Property Owner)
(Addre s, Lot, Block, Rr'-d'Al
c.)
on ec, V. Y'cc in N.C.
Nvaterbody) ( ity/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
7locati
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, boat ramp, 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.)
Xi� A-' I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Inf ation)
Signature
y de�
Print or Type Name
Mailinn Arlr/rPs.c
(Ad'ace Prope Owne Information)
Si attire
Pr�i or Type Name
J4
AAsillnrr Arlrlroec/ i

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