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JUL-26-2011 12:10P FROM:F&S MARINE 910256.3506E TC:2562497 F.1
APR-14-22010 09:52 From: To:9102563062 P.1/1
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REC'D AUG 0 5 2011 atR Natural Resources
North Carolina Department of Environment an
Division of Coastal Management Des FresmaP
9ovedy Eaves Perdue James H, Greason Secrelmy
plrodor
Governor
A NT AUiHa t FOR
Date: �l
Name of Proporty owner Applying for Permit. Name of Authorized Agent for this project
owners Mailing Address'
Sap N 6k zu" ' Sit
�s 14W, C a?Yal
Phone Number Q4d �l l d k R
Agent'ffAdroseew Aw.
roirn��..�62 Phone Number
I certify that I have authorized the agent listed above to aot on my behalf, for the purpose of applying
for nd pbtaining all LAMA Pe(mlte necesaery to Install or construct the following (eotivity)' '
(�.,,_ _ i _ 1,� ,,. �, ,,. ,ram !=�( r �i �► L �k 1.1L HL
(my property located) at
This CoAlfication A valid thru (de
8 i Iri
re ttV or Sianaturo Data
r
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION R WAIVER FOI
Name of individual applying for permit A �)�1 r��
Address of property�ar)
I hereby certify that 1 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
ensions should be provided with this letter of notification.
Please initial below if you have no objections. frCi��,
1 have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 9
395-3W within 10 days of receipt of this notice. No response is considered t!
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.
Signature & Da
DECEIVED
�sv1 WILMINGTON, i`
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RECEIVED
DCM WILMINCTON, NC
AUG 052011
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DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit A AIJ/41-
Address of property Ad��� L%4GLA ZoL� IVIV)k,ni
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit has described to me as shown one attached
drawing the development they are proposing. A desc ' n or drawing, wrttt
dimensions should be provided with this le r of notification.
Please initial below if you have n objections.�M j (5lj_*V?)j/.4 e
/��Pz
i have objections to this pro a . J '�`d A-7'b -
L.. �G�%Syr
If you hav ectionsAo-what4s being{ roposed, Pleas write the Division of Coa l
Mana nt, 127 Cardinal Drive Extension, �tN'tr min t , C� 284C ` t 1
3�iSW within 10 days of receipt of this notice. No response is considered the
►' /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 V E C
appropriate blank below.)
I DO wish to waive the 15' setback requirement. AUb U 8 2011
I DO NOT wish to waive the 15' setback requiremert:M WILMINGTON,
-' Signature & Date
Print Name
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit IN I''l,/1tn'
Address of property zqd M /1dil MPAd J rAL5 llldrh�t'�Mll PC, Z �
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit has described to me as shown on the attached.,
drawing the development they are proposing. A descripfin o ng, wig
dimensions should be provided with this le * of notification_
Please initial below if you haven objections.�jpjs�
`I have po options to this pro j-a1.
If you haves a -what isteiag-pwgsed, pledw write the Division of Coa
Man nt, 127 Cardinal Drive Extension, i mingto 284Q5 Qrss
39t2W within 14 days of receipt of this notice. No response is considered the
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.
Signature & Date
�� Print Name
C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: �em
A; l Permit #:
te: / l/ /I/
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
)itat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
H6Dredge
❑ Fill (Pr 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 0 Both ❑ Other ❑
F AND S MARINE CONTRACTORS, INC.
P.O. BOX 868, TEL. 256-3062
WRIGHTSVILLE BEACH, NC 28480
DATE J /
PAY ' If'L...Z
TO THE C > dVf
ORDER OF Q�
1 DOLL
RBC BankW' '5n rl ,
� RBC Bank (USA)
FOR
111000 390661I' j:0 5 3 L008 50i:0 2 7 200 58091I■