64066D - Ellison

'LAMA / ❑ DREDGE & FILL vv� Ip�`� 64
Ok .�
;, M IM E AL P E R M I T Previous permit #
few ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC_.,._
/ /� les a ched.
Name L j (.n 461 ?,Oh Project Location: County �Oh/✓
0/'1d Z aoa" 'l 'u., R�.
14 4, State ZIP Z$"
(1/p) ,�D(> 357 ?2Fax # ( )
A Agent Jf 1►G4'.0C
M'16W L!T6 LiffA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
es e0ono PNA �5s / no
Project/ Activity
S) /G X✓G `
!r(s)
gth
fiber
Riprap length
distance offsh e
distance offshore
Lnnel
c yards
e/ Boatlift
Idozing
�k Ale
Length
not sure yes no
not sure yes
m: n/a yes
yes
tacked: yes Rn
Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s) of
12ft 4),.1411 / 121,
Subdivision �-
City//& % ZIP -Zoe
Phone # ('?IP ) - 4 /?River Basin C!�,,d,/
Adj. Wtr. Body 16, 4
Closest Maj. Wtr. Body
(Scale:
permit may be required by: /i/�j: �%, =,{t S/'./r�LL�� ❑ See note on back regarding River Basin ru

Date
Check
Received
Check From (Name)
Name of Permit Holder
Vendor
Number
Check amount
Permit Number/Con
9/19/2014 Parker Construction Group LLC
Parker
Bank of the Ozarks
7431
$250.00 major fee, 1 Auditorium
9/19/2014.J & J Properties of Calabash 1 LLC _
Calabash Marina
Citizens South
1422
$100.00 MP 74-05 renewal
-- 9/19/2014 Seashore Realty Group, Inc. _
Heritage I, LLC
Coastal Bank & Trust
3959
$100.00 MP 64-06 mod. Reques
9/22/2014 Land Management Group, Inc.
Riverside Park Marina
First Bank
44494
$475.00 major fee, Riverside Pa
9/22/2014,Howard and Janice Malpass
same
Wells Fargo
3787,
$100.00 minor fee, Topsail Beac
9/22/2014 D� anford & Associates Land Surveying, PC
Loder-Strickland
Wachovia
1793
$200.00 GP 64064D
9/22/2014.AC & EmUy Skinner
AC Skinnard
_
NewBridge Bank
8478
$100.00 renewal, MP 23-07
9/22/2014 A'N'A Builders, Inc.
same
TD Bank
6979
$100.00 minor fee, NTB, 205 Se
9123/2014 Geoffrey &Stacy Alexander
—
same
—
Wells Fargo
2305
$400.00 major fee, Br.Co.4302 E
9/24/2014 CFPUA
same
B ofA
55808,
_ —
$800.00 Vio# 14-17D
9/24/2014 Overbeck Marine Construction Inc
Whelan
SunTrust
_
4333
_
$100.00 mod. fee, MP 36-13
9/24/2014 Coastal Marine Piers Bulkheads LLC
A. Murphy
Wells Fargo
19810
$250.00 major fee, NHCo.
9/24/2014 Bany & Shari Golob
same
Lafayette Federal Credit Uni
2770
major fee, Br. Co. Oak I.
9/24/201 Willie Richardson Construction
BUT5765
_$250.00
$800.00 GP 64007D (8JS400, GF
9/24/2014 Tidal Ventures
same
BUT
2026
$100.00 'MP transfer 42-05
9/24/2014 B & K Marine Construction
Prisilla Clark
BB&T
11511
$200.00 GP 64065D
9/25/2014 Johnny J. Williams/Land Surveying
William & Tracy Ellis
_
First Citizens_ Bank
15247
$100.00 minorfee, TB, Fender C
9/26/2014 Southeastern Coastal Construction Co
Ellison
First Federal
9243
$200.00 GP 64066D

C Division of Coastal Mgt. Habitat impact Computer Sheet
iplicant: G �� vll ` �t5 Permit
ite:
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
Lind in your Habitat code sheet.
ibitat 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 fin
disturbance.
Excludes any
restoration and.
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other F(
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 ❑ Other ❑

PIWA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Orly Eaves Perdue James H. Gregson
ernor Director
AGENT AUTHORIZATION FORM
Date:
e of Property Owner( 'Applying for Permit:
�(f LI l✓11 i 04
ier's Mailing Address:
61401 Uk
✓J=J—rA c��i
ine Number (9 t o) a ©o -. 3 5-
Dee Freeman
Secretary
Name of Authorized Agent for this project:
C�<<s e k CokLd -ra_(_ t 6--
Agent's Mailing Address:
6asa- -row 1
Phone Number Rio
!rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
"q
y property located) at Ho
o
its certification is valid thru (date) f 2
"te!Property Owner Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to C i VA 6 1- Jm (� 1 [I- 's
, -4 , � r.,\ . (Name o,fproperty Owner)
property located at01\ -1-Q !�
on 0 l� �1 e -) 0 �� � � ( ddress, Lot, Block, Road, etc.)
in , N.C.
(Waterbody) (Clty/T and/ County)
The appli ant has described to me, as shown below, the development proposed at the above
locatio .
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 drawl g
4aksZ 64 L_kJ,
� Q�2U yC 5 n
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.)
do wish to waive the 15' setback requirement.
_- I do not wish to waive the 15' setback requirement.
(Prope Ow �eInformation) (Adja nt Pro rty vyner Information)
7
Si n to vC44fA ll�, o ✓� Sig
Print or Type N me / n Print o T amen w

DIVISION OF COASTAL NIANAGE_MENT
ADJACENT RIPARIAN PROPERTY OWNER STATE'NIENT
I hereby certify that I own property adjacent to G. wA ldynC F , G S6 r/ is
(Name of Property Owner)
property located at 6 40 2 avGU Q�r�n (Zvad , rn mA%svl, �� 2
(Lot, Block, Road, etc.) ( ,
on 1��lle��s G�ce� , in �i �VnWN� M i4G %mil Y'kh, N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: cM, 2-00 - y Mailing Address: &g oz Sul n✓vi (?e4
w wc- -�-SLtD
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writ
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, N(
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
(Property Owner Irr-tion)
ig ure
Lu 6eA C � I (S e'l
Print or Type Name
6Loa
Mailing Address
rty Owner Information)
Si
PrintorType Name
low to�
Mailing Address

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