57573D - Worsley

6/22/2015
6/23/2015
6/23/15 Robert Huckabee
Money order for Brandon Grimes _ Jewell &Patricia Brown _
6/29/15 Lighthouse Marine Construction Inc Joe Mark Rose
6/29/15 ManUme Coastal Construction LLC Doug Terry
6/29/15 Hunters Appartments LLC same
6/29/15 Marion or Eula Howard same
6/29/15 Allied Marine Contractors, LLC _ j Betsy Boddie
6/29/15 Anglers Marine NC Crawford/Hamilton
6/29/15 F and S_Marine Contractors Inc I Marco Vialpando
Hidden Coast Adventure Company LLC _
_ Joseph or Lare Milligan Dellinger
Ricky Hewett Construction Reaves, Rowell, Corbett
Bailey and Associates Inc _ Grand View
F and S Marine Contractors Inc. Earl Worsley
6/23/2015
6/25/2015
6/25/2015
6/25/2015
6/25/2015
6/26/2015
6/29/2015
6/29/2015
6/29/2015
6/29/2015
6/30/2015
TrustAtlantic Bank
The Little Bank_
B of A
BB &T
PNC Bank
First Citizens Bank
NewBridge Bank
_ Branch Banking and Trust Co
TD Bank
PNC Bank
o V1vu (&_+
GP 64676D'0
59147268345 $200.00 P 64703D
5430 t2OO.00 GP 65040D_
2116 $200.00 GP for 115 Soy
565_9, $100.00 transfer fee, MI
3265 $200.00 GP for 209 E. F
2085 $260.00 GP 64681 D-
43801 $200.00 GP 64683D
_4603 $200.00 GP for 28 Pelic
721 $100.00 minor fee, ??
6180 ` $200.00 GP 64706D
4681 $200.00 GP 64707D
1116 $100.00 renewal fee, MI
4611 } $200.90 GP for 440 CaL
old -_

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Permit #;
Date:
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
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
andfortemp .
impact amount)
TOTAL Feet
(Applied for..
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated fii
disturbance.
Excludes any
restoration ani
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
U
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 ❑ Fill ❑ Both 0 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

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N.C. Division of, Cmtej iV_-nsqen^erj.
AGE N7 Ai.d'iHORIZ&-i0jj,FOE
Date: Ig�1
Nowise of Proproq ow" f ApWng for permit
' /W f I -
�Uwn 8 MlatlL17g Address:
1133 W!"itery Cutoff Road Suite 1Qa
VViimin ton C 28405
Ernaii: eworsiey(MworsieYrealeatate com
Phone (RM1 25a.n�
NarRE Of ?;.. sjsirtthi6
�'�
''
fJ,4• '�ir�.
AiDWl's *-'-* i v Address:
Ole
Esrtatt `
Pha:,G
John E. Rvarta, Eli
Secr.b r
f CSr* thid 4 have authorized tie ag!�,t Wed 2bove to ad on my �'L ' fort le PU Obe of applying
for, and obttining ail CAMA Parmits c]ewary to Install or construct the following (activity):
iC i - dfir ot�t�
For my property tow:- at
This certification is valid 9 year from (date)
6f 18f 15
Pratte Qw�+�r �rutnariter n.s�

CERTIFIED MAIL • RE:JUR !i Rexx-ZIPT RS=nU1c.S?gC
ADJACENT RIPAP.WN P'4CAER 1Y OWINER NO T inF CATiONWAiV€K FORM
to rra of Propsrt3 Ow Aoa :
t.
JIM
AAA J
I fly
Uct ow- t w, - at OkOW, city & County)
Agentst er it* ti ofi Making Address: 4. % bu- a Agehfa pt l one 0710 p ,
i hereby k sriify that i own propatty adjacent to the above mWenoed propariy. The individual
applying for this twit has described to me as shown on the attached dr�wir the deusto meat
�i they are
propo"jf� -
I have no objections to his proposal. I have objections to thus proposal.
M you hNve ONa dW* ea what Is bernp proposed, You must naW the DK*fOn of CoasWMWMW toga! (V� 0 +4*
wrltallp 10 days or nwelpf of Ws no**. Conveport hr= should be maned to 127 Cards w Drive art,
Wlirrdnpton, NC, 294054"& DCH rfprrwftW-Yw con eta be m-,bctad st (s`w►
conxkftrad
VER
t do wt+sh to wares the 151 setback r aq ulrefTwent,
i do not wish to waive Wie 15 setbacik require►�ent.
W�IWAW�W I I I�rW/WI \�I ��
(prop" OtvrW lnkrnut ")
h " 2:2C
Sk"a"Ve
Print or Type NaM
Ilia n1i 41 1 I60
AlelNrep Address
�i (Adb..nt property Owner lnfannatlan)
fit•
Tsr
4#r4 A. S
Pdnt or Type Name
3joZG4Sk(O'Vt1 �r S�
Mafiv Address
C)ofdSbbll`O,, 0 c �755 �

y
GPRTIMA MAIL • RETURN RECErPT REAwESTED
DWlliliblep� G T •;
ADJACOff RIPA.RM PRO R'Y OWNER kQ'i' MA? iCKAW ! EIR E 00ftM
Name at prr%�e:*f Omer �t�fl
AOL
Address of Pr%M y�
� . clot or Stqdt S, ftiw or koad, r„ * & Courtly}
Agent's theme hAaiiing Addmaa: 'p. / Y ego
Agent is phone C. tq JS6-304> 41*6J% 1:�.Of
�! L
r '
I hey car* thm 1 ovum property adjacent to Me above rsa<srenoed prop". The Individual
applying for this peei7iit has desoribed to me as sttr�n on the ati%ciav rteto ment r
are proposing!!,
LI thus no objections to this proposal. I have objections to this proposal.
tryou ha" r4"U&M to Wh*f is baiMPVM14 you r^1s'rotffy the DM --Ian 0.
it GoaiPai Kr+�r>•nt fi+Cafi in
WAAF +rWWA f0 der of recoo cf tts)s no to Comwp*nd#rrC& ah0 W be rra to IV t aWtrs! ariwa at,
MmkVI ", MC, 20405JW DCU mp rssrr can abo bs ccntutW at MO) 79&rdl & No mpowe is
WAIVER SECroM f VM
I unde,-atand time s pier, dock, mooring pilings, breakwater, boathouse, rift, or grain must be set
back a minimum di.�� of IV from my area of riparian ac ess unless weaved by rile. (if you
vAsh to waive the Ztbscik, you t Inall the appropriete blank below.)
—1 do wish to waive the 15' setback requirement.
— I do not wish to waive the 16 setback repuirernent.
(PMPOTtY Owner Intormation)
Y\ IN1 W N
Signature
----�-
,1
PnW or Type Name I --
MIA Mi 1 &L ru j�tr�� Sui y 10)
Making A teas
W d r tliythun . ILL ZEjki 6
CRy/Srat■ Zo
�11 (Adj cefft Pfava :y Owner Inf®rrartion)
Sigruawe
Print or Tye Names—�
ZhPL—
M&6v Adrtiess
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