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I'IILUl1IPXI UI:Ub YN Uollett & Associates YAX No. 'lU4UJbUb54 r, UU2
-17-2011 07:44A FP.DM:F&S MPPIhE 9102563062 T0:1704335SG54 P.1
4R-14-MIO 09:52 From: Ta:910256306Z P.PI
North Carolina Department of Envlranment and Natural Resources
Civision of Coastal Management DaFmww
egvsrty haves Per�ub .lames H. C093M Seaatary
Direclo�
Governor
AGENT ALI OR17 1ptL
Date.
Name Of ProPOMY Ovvret APOYIng for Permit.
Njq� tt pd Aunt farthis protect
pwner'e 14fai11ng Address:
Agerire Mailing Address:
4 0�l P.O. Box 2W
Phone Number
Phone- Numw
,304
u �f
I certify that 1 have aut�anzed tna agent iigtad above to act on my behalf, for the p rpGSC ePPyn9
. . . _n w i L a A to inatal) or Construd thb following (aCtivlty):
(my propny located) at
This cwificati0n is VWid thru (date) �1
4, (4PI y
Date
property Owner Signature Low �� J
./ J

F&S Morino Contractors, Inc.
Complete Marine Construction Servic
For Over 32 yearsl
CAPT. ED FLYNN DURVi
Piers, Floating Docks, Pilings. Bulkhead,
Boat Lifts, House Pilings, Repairs
P.O. Box aw Phone/Fax: (9
Wrightsville Beach. NC 28490 email: e
C1��S�„��n�

OL
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FO
Name of individual applying for permit �l/f�l ir1+060-62'
Address of property �°'� % L'tNl �t '� �� "� /fC bl N
I hereby certify that I own property adjacent to the above referenced property.
individual applying for this permit has described to me as shown on the attach
drawing the development they are proposing. A description or drawing, Witt
dimensions should be provided with this letter of notification.
Please initial below if you have no objections./,f,J f'�SX7L'1
I have no objections to this proposal. /41D'K""l hl`�`
If you have objections to what is being proposed, please write the Division of Cc
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 9
3 within 10 days of receipt of this notice. No response is considered t
U l j { same as no objection if you have been notified by Certified Mail.
WAIVER SECTION ///-
I understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must be set back a minimum 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 15' setback requirement.
&Ie..& �U/b- Signature & Date JUL0 5 2

u n Ic i ip 111iacn
-30-2011 11:34A FROMF&S MARINE
.7 1 VVVVV`"Ii F.1.
9102S&3062 TO:6866403 P.1
DIY♦SIGN OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Nae of individus! applying for Peed A.
md ',j l mom m
Addrimof .otaer�r � Ai^r 1a7' MiA YL/ 29W
I hereby l/ #W I mm property agent to 9w above referenced propertY. The
indiVidual applying for this puynit has described to mC 88 shown Cm the art shed
dmwing the devekg rnent they an pmposin8• A desk:raption or drawing, with
dirmmnsiona should be provided with this letter of noMmtion.
please m� below if You have no objectiommr. 'IvApo 8 LWM� r)
� this
no ob,
if you have objections to wtot is being proposed. P*ase writ tlw Mvii of Coast'
Management, 127 Cwdb* Drive Etiernion, Wdmingtm, N. C. 28405 OF Cad 910-
3p*3WwitW* 10 dove of mceipt of Iles notice. No mWonse is conakkwW the
79d 221T- same es no +objscri+'m if You have been notified by Cw# fed Ntail.
w1wER sEcnoN
I understand that a pier. dock, mooring purge, break water',boat hatme.lift or
sandbags moat beed back a minimum of 15, from ray area
unless waived by M&(Nyou wish to vmwe the setback, you must initial Ilya
appropriate blank below.)
100 wish 10 waive the 15. setback requlmamnt.
I DO NOT wish to waive the 15' smock Wit.
�' 1
V.. _ _-- Signature & Date
--mint Name
JUL 0 5 20
DCM WILMINGrc

C -Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: ���,,�� Permit
te:
Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
DISTURB TYPE
)itat Name 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

PAY
TO THE
ORDER
F AND S MARINE CONTRACTORS, INC.
P.O. BOX 868, TEL. [phone]
WRIGHTSVILLE BEACH, NC 28480
xlC ��J P lE'
RBC Bank'" (W5q 41Q,
♦� RBC Bank IUSA)
" i j ,C '
R ®'� I ��G���'k�'�'
FO
n'000 3 90 2 91I' ':0 5 3 L008 50l:0 2 7 200 580 91I'
39029
DATE / J,l 6685/531
$ '-�L'D j7d
DOLLARS 6
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