65002D - Petrilla

DENR CAMA Dailv Check Loa for WIRO
Date
Check
Received
Check From (Name)
Name of Permit Holder
Vendor
Number
Check amount
Permit Number/Con
10/14/2014 Samuel W. or Tracy Clary
Middle Sound Marina SunTrust
4139
$100.00 renewal, MP 164-07
10/14/2014 Coastal Marine Piers Bulkheads LLC
Ken Kolling/transfer to Shawn Nasseri Wells Fargo
19854
$200.00 transfer and mod., MP
10/15/2014 Edward Stokes Parrish or Margaret Waller Parrish
Historical Society of Topsail Island PNC Bank
804
$100.00 mod. Fee, MP 86-05
10/15/2014 First Community Bank certified check
Maritime Coastal Const./William Thome Moneygram Payment Sys. In
35069222
$50.00 returned check fees/chi
10/1/2014 First Community Bank certified check
Maritime Coastal Const./William Thom<Moneygram Payment Sys. In
35067797
$400.00 to cover GPs 63273D E
10/15/2014 Connaway Marine Construction, Inc
Amanda Chaney & Lee Thornton B of A
6852
$200.00 GP 64096D
10/16/2014 Richard L. or Erica J. Penny
same
' USAA Federal Savings Bank
716
$200.00 reissue GP 63924
10/17/2014 MoneyGram/Brandon Grimes
Wells Fargo Bank
59098505697
$400.00
10/17/2014 Western Union Money Order/Brandon Grimes
Paul Fornwald
Wells Fargo Bank
17-081677370
$200.00 GP 64097D ($800 total
10/17/2014 Western Union Money Order/Brandon Grimes
Wells Fargo Bank
17-058990188
$200.00
10/17/2014 Allied Marine Contractors LLC
Daniel Winfield
B of A
6873
$200.00 GP @346 Admirals Co
10/17/2014 Samuel W or Tracy Clary
same
SunTrust
4142
$100.00 mod. Fee, 164-07
10/17/2014 John Allen Odham III, Nancy Odham
John Gray Hunter, Jr.
PNC Bank
946
$100.00 minor fee, 406 N Shore_
10/17/2014 Holden Dock & Bulkheads
Simpson
First Community Bank
5928
$200.00 GP 61640D
10/20/2014 Overbeck Marine Construction Inc
Bill Wagoner
SunTrust
4347
$200.00IGP 64099D
10/21/2014 Merril or Louis LeMoine
same
B of A
143
$200.00 GP 64100D
10/22/2014 Eugene Haley & Elizabeth Haley
same
B of A
1594
$250.00 major fee, Haley, NHC(
10122/2014 TTEREVE Enterprises, Inc.
same _
-BB&T
1081
$475.00 major fee, Ttereve, On,
10/22/2014'Southeastern Coastal Construction Co
Wendell Murphy, Jr.
First Federal
9289
$200.00 GP 212 Seacrest Drive
10/22/2014 Allied Marine Contractors LLC
Marvin Rozear
B ofA
6940
$200.00 GP 1283 Corcus Ferry
10/23/2014 F and S Marine Contractors Inc
James Petrilla
iPNC Bank
4101
$400.00 GP for #4 Sunset Stree

4C*Divislon of Coastal Mgt, (Habitat impact Computer Sheet
applicant: v1� V' `' 1' R Permit #: U%b)\
)ate: (
a� �y
lescribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
)und in your Habitat code sheet.
abitat 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 fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
Dredge Fill Both Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ 01' %..\ )
Dredge ❑ Fill ❑ , `(
Dredge ❑ Fill ❑ Bot
Dredge ❑ Fill ❑ Both L �_ �J'^\► '
Dredge ❑ Fill ❑ Both ❑
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 ❑

Pat McCrory
Governor
K WJ
NCDENR
North Carolina Department of Environment and Natural Resources
N.C. Division of Coastal Management
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date
N!5W of Pro rty pwner Applying for Permit: Name of Author ed Agent for this project:
s idt�'Ic
r- , 1 4 C� ��y 77
yI'S� �%' � �
Owner's Mallln Address:
�7yylr�,iy ,t1I, a�,�l�
Email: ll
Phone
Agent's Mailing Address:
P.O.8ox�68
Email:
Phone
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and Qbtaining all CAMAA Permits nerJAA01
sary to install or construct the following (activity):
u
For my property located at �
kLl,
This certification is valid t year from (date) D "' of
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