55864D - Forbis

CAMA / ❑ DREDGE & FILL
MNERAL PERMIT Previous permit # f
INew ❑M'odification El Complete Reissue El Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources --:�?/ i ��
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules a ched.
Name �Gls'Qh 1 l"Qi^ ,S Project Location: County -IVIitil/ G1�l�!
30 aj� Street Address/ State Road/ Lot #(s)
Ttwo
Aokir h ., State�'L� ZIP225V 903 6�'~
( /YX # ( ) Subdivision
GG l- /
ed Agent ��5/�w12 V�� !�►i'/hr//r City��i/'�b� 4" /�P�C� ZIP S
(� PfW' {�fA ❑ ES ❑ PTS Phone # (IV, ) �e'9Zd River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body A9Z 1.� bra ` c�nat 141,
❑ PWS: ❑ FQ I.,/
yes no PNA yes Crit.Hab. yes / no Closest Maj. Wtr. Bodyh�"��l Cy-r.111
roject/ Activity o > 4 Z
d
7 f {r7 11/)
ck) length
ier(s) 40
Y
ngth -�
tuber �
d/ Riprap length lie
distance offshore_ /r
I
Lc distance offshore }
i
cannel
i
)ic yards _i
ripi
0
ise/ Boatlift
` f'�•
ulldozing -
/ f/' /
re
e Length
jnot sure yes ,a �--,-
s: not sure yes o
cum: n/a yes V)
no
Attached: iSef/ no—
ng permit may be required by:
U
(Scale: / J/'
❑ See note on back regarding River Basin n

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOA TLIFTIBOATHO USE)
I hereby certify that I own property adjacent to �D r` t' L ' �� r- ' S 's
(Name of Property Owner)
property located at C a- `' -�� ' v e - '
(Lot, Block, Road, etc.)
on jti�: Y+Ie. ClV-byt - rat: , in (�VCxa"CV, 04%.- ( � C� 1 , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 1`� -SS I -G J J q Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (IT) from my area of riparian access unless
-' "-----7opriate blank
)mplete items 1, 2, and 3. Also complete
m 4 if Restricted Delivery is desired.
int your name and address on the reverse
that we can return the card to you.
tach this card to the back of the mailpiece,
on the front if space permits.
ticle Addressed to:
^r. pain VeAej2 evi1le.
1419 Lz5b�5 &Cd
�Jej j Nc ���► rp
A. Signature
X
B. Received by ( Printed
D. Is delivery address d'dferent from Item 19
If YES, enter delivery address below:
❑ Agent
Delivery
3. a ce Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
ticieNumber 7009 0080 0001 7476 3608
ansfer from service /abed
orm 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
(Information for Property Owner Applying
for Permit)
Mailing Address T—
JPMENT:
(Riparian Pr rty Owner Information)
-- Lure
-k i o(-" M Co'se-
City/Stat /Zip Print o Type Name
/,If/6? ---?/_'N ?-7<':::::)

a © C4-j v i./t-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILIIVGSBOATLIFTBOATHOOSE)
I hereby certify that I own property adjacent toJ s `s
(Dianne of Property Owner)
property located at '
(Lot, Block, Road, etc.)
�fle- Gworc � hC�l , in I� I r�F� � � �'1 , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: �l` -`? �� i q Mailing Address:
)1
4�`
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I S) 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 not wish to waive
-Ir I do wish to waive that setback requirement.
-----------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual Proposing development)
-----------------------------------------------------------
(Information for Property Owner Applying
for Permit)
(Riparian Property Owner Information)
Mailing Address
Signature

WINNTER MARINE CONSTRUCTION & SALVAGE, LLC
406 Atlanta Ave Carolina Beach NC 28428
armenew�mneya:aoi-co
[e-mail] 910-547-3206
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SS1I1I1 ifiI
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3everly Eaves Perdue James H. Gregson Dee Frei
Jovernor Director Seca
AGENT AUTHORIZATION FORM
Date: ?S — 1 iJ — Jo i Q
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
ol riots ' ?�'T yr iL �x/I �%,=
Wner's Mailing Address:
flftl
JxAk s��� , NL
'hone Number (q 6) 6S7 — 5 q —11.
Agent's Mailing
sn Address:
c r9- ;Z1 N h f r G rf A.' C_
Phone Number (?AEI) `i 147 3 :Z
certifv that l have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or construct the following (activity):
;my property located) at 0 3 (�L� n ti-� �'r'ye- 4 �; n c`
This certification is valid thru (date)
t y y
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STA'FE;MENA'
(FOR A PIER/MOORING PILINGS/BOATLIFTIBOATIIOUSE)
I hereby certify that I own property adjacent to �D u-5a r% nJ) L s
(Name of Property Owner)
property located at CY. c 1 Dr-,` V C
(Lot, Block, Road, etc.) n
on M YL I2 CAVbVe- , in rla - o l l rl4a- I' t C �l , N.C.
(Waterbody) (Town and/or County)
AppIicant's phone #: glq -S 51691 q Mailing Address:
1
k l i S
- C i n cUL—k
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I T) 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 not wish to waive
I do wish to waive that setback requirement.
------------------------7------------------------------------------------- ------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development) < #�
U
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address ture
�-6N
City/Stat /Zip Print or Type Maine
Q 16 r�--7 Cq -1 4 q /9 6 ?- --?- 0?-�2-3

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: »� / z—. fivkA/! Permit #:
Date: / l
qllp
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
found in your Habitat code sheet.
Habitat 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 (
l 5, 9
r
Dredge ❑ Fill ❑ Both ❑ Other �
3
/ r
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 171

DAVID C WINNER JR
PH. 910-458-4577
PH.910-547-3206
406 ATLANTA AVE
CAROLINA BEACH, NC 28428
SDNr
1306
66-112/531
BRANCH 02501
BMT
BRANCH BANKING AND TRUST COMPANY
1400-BANK BBT BBT.com A NP
i:053 LO L L 2 Li:00052958564 L3II'0 1306