64778D - Warren

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/LAMA / ❑ DREDGE & FILL +
WNERAL PERMIT
New ❑Modification [-]Complete Reissue ❑Partial Reissue
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources y�
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC !� ' / �-- 0,�
[j;&lles attached.
Name 9141V Project Location: County�y/P�,�y s►t%'i!//
�1•► / Street Address/ State Road/ Lot #(s)
State / ZIP $ 4&2 A1
( F26'3y Fax # () �1:�AI Subdivision /
ad Agent `ill , , City VYI''I44&✓1�� /Se/+s11 ZIP
❑ CW ❑ EW fJOTA ptS ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A y
❑ PWs: El FC: Adj. Wtr. Body % / 5 �� (n�trlfi
ies / no PNA yes no) Crit.Hab. yes / no Closest Maj. Wtr. Body
�rrrhY/�1r �duh
Project/ Activity
i
(Scale:
k) length ----
gth
fiber
Riprap length
distance offsh
distance '�
innel
e/
Ido g
(lG� lY
g k/`
Length as
not sure yes
not sure yes n�
m: n/a yes
yes
tached: yes ---� —_.
permit may be required by:
Lam' • ,Z;PWKAee note on back regarding River Basin ru
1"--") - /

7/16/2015
7/24/15
Morgan or Erica Mahler
Highland Shores HOA
Park Sterling Bank---
7 $_1_00.00 renewal fee, _MP 1 �
101_$2
859
400.00 GP for 1304 Caroli
7/17/ 0015
-7/20/15
Stanley or Sharon Stubbs
same
B ofA
7/17/2015
7/20/15
_
Richard or Sharon Love
same
Wells Fargo Bank
1434
$200.00 GP 64712D
7/17/2015
7/20/15
Antinori Construction, Inc.
Chris Mohr
B of A
3780
$200.00 GP 64715D
7/17/2015
7/20/15
Holden Dock & Bulkheads
Anna Odam & Rufus Yates
CresCom Bank
2181
$200.00
GP 64697D
7/17/2015
7120/15
Atlantic Coast Industrial LLC
David Brinkley
BB &T
11791
$200.00
GP 1400 Point Hai
7/20/2015
7/24/15
Money order from Brandon Grimes
Patricia Welfare
Wells Fargo Bank
17-213876532
$200.00
GP 64717D
7/20/2015
7/24/15
Robert or Candace Rice
same
BB &T
10394
$200.00
GP 65041D
7/22/2015'MHCD
River Bluff Holdings LLC
same
?
1121
$100.00
renewal fee, MP 6:
7/22/2015
7/24/15
Richardson Construction
Michael O'Hern
BB &T
6063
$600.00
GP 64698D @$201
7/22/2015 7/24/15
7/22/2015 7/24/15
Backwater Marine Construction Inc
Clements Marine Construction Inc
1 Coastal Earth Works Inc.
Town of Oak Island
Waterfronte Villas Owners Assn./CAMS
Lennon Smith
Geneveive Cassese
Matt Hendrix
David & Ann Sneeden
Rick Edwards
same
same
David and Diane Rodger
James Bresee __
CJL Partners, Inc
GP 64700D (d$201
GP 64699D @$201
BB &T
2017
$200.00
GP 64701 D
First Citizens Bank
3856
$200.00
GP 64756D
7/23/2015
7/24/15
First Bank
4236
$200.00
GP 64734D
7/24/2015
BB &T
59968
$100.00
mod fee, MP 152-(
7/27/2015
North State Bank
1703
$100.00
transfer fee, MP 84
7/27/2015
Logan Marine LLC
Corning Federal Credit Union
First Citizens Bank
First Citizens Bank
1208
$200.00
GP 64777D
7/27/2015
Charles Riggs & Associates Inc
14102
$100.00,minor fee, NTB, Oi
$100.00 minor fee, 1538 S.
$100.00 minorfee, 120 N. ;
7/27/2015
Charles Riggs & Associates Inc
14099
7/27/2015
Charles Riggs & Associates Inc
CJL Partners, Inc
First Citizens Bank
14100
7/28/2015
Trip Pippin
_
Rudy Warren
Wells Fargo Bank
8579'
$200.00
GP 64778D

NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: ual` j/ 41meAl Permit* k7?g
Date:
7/,5/ /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.
-labitat 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 arnoount
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
✓l/
Dredge ❑ Fill ❑ Both ❑ Other oc
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 0 Fill 0 Both ❑ Other ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date fJ�
Name of Property Owner Applying for Permit:
Mailing Address:
L
I
�r
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and ob aining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
�� Al. �1��tm' e / z61z�,
This certification is valid thru (date)
Property owner signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1
I hereby certify that I own property adjacent to GUl�ri s
tt11��tt �� N me of Property Owner)
property located at �j/-� /r , eJXj`M & % �jV e
(Address, Lot, Bloc , oa etc.)
on I , inl// ��f'�� 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)
RECEIVLG
DCM WILMINGTON, N
JUL 2 8 2015
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.)
1 do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
(Pr Owner Information) Adiac nt Prope O r Information)
Si zrre r r' Si tru
Print o�T�rpe Narh��40 /1_ Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to `(4Y r s
{N a of Property Owner)
property located at 4 '�(,L /?
(A?dress, Lot, loch, oad, / /
on in % �'6t /S� , QC�J 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
Qndividual proposing development must fill in description below or attach a site drawing)
RECE6�,I 7-r
DCM WILMINGTOINN
JUL 2 8 2015
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. (lf y u 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.
Information)
9-L ;V rM4�,✓,�G 41 P--
Adjacent Property Owner Information)
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