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Home My WebLink About64085D - SmithYA%jFjF VAF Date Check Check Received Check From (Name) Name of Permit Holder Vendor Number amount I Permit NumbeNC 12/10/2014 Sun Technologies Sandeep Sharma B of A 5073 $436.00 Vio#14-11 D 12/11/2014 Boatzright Inc. Kevin Thomas First Citizens Bank 1805 $200.00 GP 65069D 12/11/2014 Holden Dock & Bulkheads Don & Elizabeth Whitener First Community Bank 5955 $200.00 GP 64061D 12/11/2014 S&ME USS North Carolina 113of A 4728 $400.00 major fee, Wilmingl 12/12/2014 Riptide Builders, LLC same, owner Donald Bean _ BB&T 7525 $50.00 minor exemption fe 12/12/2014 Holden Dock & Bulkheads -- Dodson, Baxter, - -- B&T Community Bank 7988 64085D, 64088 12/12/2014 Charles and Carol Walters — �senr*e— SYti C�� $200.00IGP GP 64085D IC Division of Coastal Mgt. Habitat Impact Computer Sheet pplicant: �uY t (� C �� ^-� Permit #. WOSSD ate: escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement >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 fina disturbance. Excludes any restoration andh temp impact amount) oz� Dredge ❑ Fill ❑ Both ❑ Other H -Z— Z 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 ❑ Pat Viccrory Gokfartlor A 2 Ws�q North Carolina Department of Environment and Natural ResoLirces N.C. Division of Coastal Management John E. Sk,arla, ;ii Secretary AGENT AUTHORIZATION FORM Date: Z 6- /4/ mama of Property Owmar Applyirg for Permit: Name of Au tt rize d Agent for this protect: ZS Owner's Mailing Address: Agent's Mailing Address: Email: 61 ��1 SiT,�.@ `q.i~e Phone C 0,01 Email: ebP1e@,fU1J 75;r— 4 -'fRe�fV� Phone ��3 i certify that I have authorized the agent listed'' above to act on my behalf, for the purpose of applying for, and obtaining all LAMA Permits necessary to install or construct the following (activity): For my property !mated at / % � `� li,,�� 1��nA,6C Art- ?..a 67 - This certification is valid 1 year from (date)? Pvouerty C WPiar 9iio nsture Mass, IRy p J 3141) rx Itj S L.' 4Fxl��°•vls PJ c�� folio , " 1 1 I '0 IFA� pjaeo D MJSTOCoM,j,0N () : UKIGtNAL Inst # 143416 Boost 1691Page: 1332 nowt KAVY IN CAUSEWAY OR. OCEAN ISLE NEACN N.C. 26460 MAIM 90" ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to (7"4 (OA/'a (5 property located at _Z 2 �N of Property Owner) on a��- w l� (Address, Lot, Block, Road etch. f { ft 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 1 have no objection to this proposal i have objections to this proposal. L31:8CRIPTION 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, 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.) lV 4 1 do wish to waive the 15' setback requirement. ,L1L49--- I do not wish to waive the 15' setback requirement. (Property Owner nfo ation (Adjacent Property Owner Infors-nation) Zaau Signature Signature � 0 ��2� � �76gi`%�� Print��orT��ypeName Print or Tyne Name M iting Address._ Mailing Addre _ r✓<ty/ tate2iA,„ „ „ „ Crfv/state2io ADJACENT RIPARIAN PROPERTY OWNER STATEMENT i hereby certify that i own property adjacent to �� t01� property located at� (Na, of Fr rt Owner) az- (Address, Lot, Block, Road etc. (Waterbody) ` -- M.C. (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 ANWOR 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, 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 16 setback requirement. (Pro arty Owner Info tion) (Adjacent Property Owner Information) Signature � Si tore. �pp Print or Type Name Print or Type Name M ;ling Addres Mgding Address c � r� Z(�y6 (`K!:sue T z e!: t(ytafelZip,R ^ a Crf��/Sfate2tn ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 6':;,e 0>2 /(4 67 Painewo�f Propert Owner) property located at Z 7 g �i� _) �Q ,�� ! , 1 1 i (Address, Lot, Block, Road etc.) on _ tN /ii/ in ( ��9� �G c� ��.�Cl/ N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 11 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; breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. `, you 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. (Property owner Info ation) (Ad er�t roperty O n r info, lion v1 , Signature Sign ture Print or Type ,Uarne Print or Type IV me t%? ihng Addres Mail g Ad ress t � ��' i3 �ct1,N 2��6rj M %_s4c' hzC C1ty1§tate2ip _ _ _ _ _ _ CiNIStata _in -