20120281 Ver 1_CAMA Application_20120316

A PW
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue
Governor
March 13 2012
MEMORANDUM
FROM
SUBJECT
Applicant
Protect Location
Proposed Protect
Braxton C Davis
Director
Karen Higgins
Division of Water Quality
Doug Huggett
Major Permits Processing Coordinator
Dee Freeman
Secretary
20 120 28 1
Qr=oec��
MAR 1 6 2012
DENR WATER QUALITY
WETLANDS AND STORMWATER BRANCH
CAMA/DREDGE & FILL Permit Application Review
Carl E Wallace
Carteret County, adjacent to the South side of Bogue Sound at 104 Forest
Knoll Drive, Atlantic Beach
Proposes the removal of an existing shorter pier and the placement of a longer
pier, two covered platforms and the relocation and placement of two boathfts
Please indicate below your agency's position or viewpoint on the proposed project and return this form by
April 3 2012 If you have any questions regarding the proposed project please contact
Heather Styron Permit officer at [phone] When appropriate, in depth comments with supporting
data is requested
REPLY This agency has no objection to the project as proposed
This agency has no comment on the proposed project
This agency approves of the project only if the recommended changes are
incorporated See attached
This agency objects to the project for reasons described in the attached comments
SIGNED DATE
400 Commerce Ave Morehead City NC 28557 NorthCarol�na
Phone [phone] FAX [phone] Internet www nccoastaimanagement net
An Equal Opportunity 1 Affirmative Action Employer AiatumlIff

DIVISION OF COASTAL MANAGEMENT
FIELD INN ESTIGATION REPORT
1 APPLICANT'S NAME Carl E Wallace Atlantic Beach
2 LOCATION OF PROJECT SITE Adjacent to the south side of Bogue Sound at 104
Forest Knoll Drive Atlantic Beach Carteret County
Photo Index 2000 grids 40 509 K (8) L (8)
2006 grids 40 8084 J (8) K (8)
State Plane Coordinates X 2667814 005 Y 354357 073
Longitude 76 °46 40 41 Latitude 34 °42 1120
3 INVESTIGATION TYPE CAMA
4 INVESTIGATIVE PROCEDURE Dates of Site Visit — 3/7/2012
Was Applicant Present — No
5 PROCESSING PROCEDURE Application Received as complete -2/27 /2012
Office — Morehead City
6 SITE DESCRIPTION
(A) Local Land Use Plan — Town of Atlantic Beach dated 7/24/2008
Land Classification from LUP — Single Family Residential/ Conservation
(B) AEC(s) Involved CW EW PTA
(C) Water Dependent Yes
(D) Intended Use Private /Community
(E) Wastewater Treatment Existing — onsite septic system
Planned — None
(F) Type of Structures Existing — dock with platforms and boatlifts bulkhead
house driveway decks boardwalk high ground boat
launch
Planned — pier, covered platforms and boatlifts at relocated
location
(G) Estimated Annual Rate of Erosion N/A
Source — N/A
7 HABITAT DESCRIPTION
liZ?T' Tlnrn UTT T VT*t i \TTTTT
(A) Shallow Bottom
N/A
N/A
1 111J1\
3 592 ft2
mcorp /shaded
(B) Submerged Grass Beds
N/A
N/A
2 480 ft2
Inco /shaded
k ) 1 ULai ruca iJISLUMea o u /Z Ii`
(E) Primary Nursery Area No
(F) Water Classification SA HQW Open Yes
8 PROJECT SUMMARY
The proposed project is for the removal of an existing shorter pier the placement of a

Carl C Wallace
Field Investigation Report
104 Forest Knoll Drive
Page 02
longer pier two covered platforms and the relocation and placement of two boatlifts
9 Narrative Description
The Carl E Wallace project is located on the south side of Bogue Sound at 104 Forest
Knoll Drive Atlantic Beach Carteret County The project area is found by turning off of
Highway 70 East in Morehead City (Arendell Street) onto the on ramp for Atlantic Beach
Follow the Atlantic Beach Causeway to the four way stop light intersection then turn right
onto West Fort Macon Road Follow West Fort Macon Road for 2 24 miles and turn right
onto Lee Drive (adjacent to White Swan Restaurant) Follow Lee Drive until it merges
with Forest Knoll Drive The site is located on the right along the south side of Bogue
Sound
There are no pier permits on file for this property however the pier permitting for this area
was previously done in the past by the LPO s (up to 200 ) and as such DCM would not
have a copy Office research has verified that there are no cultural or archeological
resources within this area Aerial photography shows the existing pier has been in place
since the early 1990 s
The high ground property for Carl E Wallace consists of a single family residence with a
driveway decks bulkhead pier high ground boat launch and boardwalk It consists of
typical grasses, shrubbery, pines and a 45 x 80 expanse of coastal wetlands consisting of
Spartma alterrnflora (Smooth Cordgrass) The total shoreline for the tract is 80 is 17 120
square feet in its entirety and has an average elevation of 6 above NHW
The proposed development is a private project There are single family residential
properties to the east and west of the protect area The Town of Atlantic Beach s Land Use
Plan classifies this project area as Single Family Residential with all parts of the AEC
classified Conservation Bogue Sound is not designated as Primary Nursery Area, is open
to the taking of shellfish and carries a water classification of SA/HQW The width of
Bogue Sound per Google Earth is approximately 1 5 miles within the project area Per the
applicant the water depths are an average of 15 nlw to 5 10 depending on location
with connecting water depths an average of 6 nlw Through field verification on 3/7/12,
the water depths were found to be an average of 1 nlw to 3 nlw however this was due
to the moon phase (99% visible) on that day which would cause an extreme low to occur
Scattered oysters were observed adjacent to the coastal wetlands bordering this property
SAV beds were also observed during the field investigation at a distance of 500
(more than 100 beyond what the applicant showed) however within the proposed lift areas
(approximately 450 waterward of the edge of marsh) the water depths are greater than 2
nlw Substrate in Bogue Sound is mostly sand There are longer piers (approximately 500
plus from the edge of marsh) to the east and west of the project location The proposed

Carl C Wallace
Field Investigation Report
104 Forest Knoll Drive
Page 03
docking facility would not extend beyond the established pier length along this shoreline
as well as would not extend into the deep water /channel area The channel within this area
is approximately 540 from nhw
10 Project Description
The current proposal is to remove the existing shorter two slip docking facility replace
with a longer pier add two covered platform areas and relocate the existing slips (with
boatlifts) to the deeper ( >2 nlw) water at the new 11 X 30 platform location
Due to the shallow water depths over a large expanse of SAV habitat the applicant
proposes to remove the existing shorter dilapidated pier platforms and slips They are
proposing a (longer) 6 x 474 pier The current slip location is located over a shoaled
SAV area with water depths < 1 nlw so in order to achieve the necessary depths to span
this shallow SAV habitat the pier would need to exceed 400 from the edge of marsh The
water depths from 400 to 500 would maintain the required 1' of fall as well as the deeper
water depths ( >2 nlw) over the SAV habitat
The proposed pier would extend from the existing bulkhead over coastal wetlands for
approximately 45 over scattered oysters for 6 and over open water and SAV habitat for
the remaining 423 An 8 x 10 covered platform would be located a distance of
approximately 240 from the existing bulkhead (195 from the edge of marsh) and would
be located on the west side of the pier An 11' x 30 platform with an 8 x 10 covered
section would be located at the end of the pier (approximately 420 from the edge of
marsh) There would be two slips (existing slip areas relocated) with 13 x 13 boatlifts
located on either side of the platform The new slips areas would be relocated a distance of
285 beyond the old slip location which is currently a distance of 200 beyond nhw has
shallow water depths ( 1 5 nlw) and is directly over SAV habitat The proposed docking
facility would not extend beyond the existing pier head alignment along this shoreline
11 Anticipated Impacts
The increases in suspended sediment and turbidity levels from the pier placement will be
temporary occur while the pier placement is taking place and should be minimal given the
bottom composition To the maximum extent possible the pier should be located as to
avoid SAV habitat (as shown on plat 3 of 3) and should not exceed a maximum distance of
504 from the existing bulkhead to ensure that it would not exceed the existing pier head
alignment along this shoreline It should also follow the Riparian Corridor alignment
determined by DCM on 4/4/10 The relocated slip areas would be reduce the likelihood of
prop scarring and incidental prop dredging of the existing SAV habitat The current

Carl C Wallace
Field Investigation Report
104 Forest Knoll Drive
Page 0.1
existing slips are located over a shoal area of SAV that is within shallow water ( 1 nlw )
The deeper water depths (> 2 nlw) within the proposed boatlifts location and the shorter
distance that the applicants would need to traverse in order to reach the deeper
water /channel area has the potential to help preserve and re establish the SAV habitat
closer inland The proposed docking facility should not cause an interference to navigation
due to there are longer piers adjacent this and because the channel /deep water is located a
distance of approximately 50 beyond the proposed 11 x 30 platform area
Name Heather Styron Date 3/13/12 1 Morehead City
i

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Dom N? 1
APPLICATION for
Major Development Permit
(last revised 12/27106)
North Carolina DIVISION OF COASTAL MANAGEMENT
1 Primary Applicant/ Landowner information
Business Name
Project Name (if applicable)
Applicant 1 First Name
L 0
MI
�d
Last Name
Ida l i C-
Applicant 2 First Name
VJtQ/404 1
MI
Last Name
114
If additional applicants please attach an additional page(s) with names listed
Mailing Address
a �� A4 re- QLk � &C�
PO Box
City
&".irN v
State
ZIP % +
/ 2- 1
Country n
(46 A
Phone No
13,36 Shy (, yU� ext
FAX No
Street Address (if different from above)
City
State
ZIP
Email
C �� �i a� C_ I C1r iaoc.,-1 - «M
2 Agent/Contractor Information
Business Name
B / A ,e- WeLf c✓- %ylu�►N�
Lp /,f SfNU --t/ o,, ��vc
Agent/ Contractor 1 First Name
4 Jc N
MI
6
Last ame
t :1 I e
Agent/ Contractor 2 First Name
MI
Last Name
Mailing Address
PO Box
9-3
City
/n®cAe-hea-
State
iYe
ZIP �j �'` %
0 J /
Phone No 1
�5 ^� S-Uy 0737 ext
125.1 hone No 2 / ?
WC, 9631 ext
FAX No
Contractor #
Street Address (d different from above)
City
State
ZIP
Email
<Form continues on back>

Form DCM MP 1 (Page 2 of 4)
APPLICATION for
Major Development Permit
3 Project ,Location
County (can be multiple)
Street Address
State Rd #
CC," �.r ^r- . --
/ Fvt zS+ Kgot t
6 a'
Subdivision Name
City
State
Zip^
JJ y
N
Phone No
Lot No (s) (+f many attach additional page with list)
ext
1 Vegetation on tract W (;oJ e ck /4, JtA C ,yAt�. t�y,P [oMS ` s f s o 7F pO IPle 5 / C( AA g / .40 q Pf f It,5
a In which NC river basin is the project located?
b Name of body of water nearest to proposed project
l� �o � ,
t^0. Se -AJ#C yuV,- t.,u55 + fo
, fA�,de 4 c,
c Is the ater body identified in (b) above natural or manmade?
d Name the closest major water body to the proposed project site
%LW4
atural ❑Manmade ❑Unknown
16 TAC
e Is proposed work within city limits or planning jurisdiction?
f If applicable list the planning jurisdiction or city limit the proposed
es ❑No
work falls within
4'14"v f i, &,t, N c,
4
Site Description
a
Total length of shoreline on the tract (ft)
b Size of entire tract (sq ft )
6 a'
-1 14 ` X �'o f / I / 2a .41ol,4,,,
c
Size of individual lot(s)
d Approximate elevation of tract above NHW (normal high water) or
NWL (normal watWNHWorONWL vel)
(if many lot sizes please attach additional page with a list)
e
1 Vegetation on tract W (;oJ e ck /4, JtA C ,yAt�. t�y,P [oMS ` s f s o 7F pO IPle 5 / C( AA g / .40 q Pf f It,5
t 000 % e.+)+ I , k e— � - + C tS iy v�� y'(--5S-CT l� ' rkU,
tG"
l� �o � ,
t^0. Se -AJ#C yuV,- t.,u55 + fo
, fA�,de 4 c,
5t .AN -J1L�
I
Man made features and uses now on tract �d ! © j` y r p / t�
`C(1
�iQ i.at t;A, o, t !-f au SC era �� ��e-IZ %tom
G C{ a et
g
Identify and describe the existing land uses adjacent to the proposed project site
I deo\J�a( �`%w��S onf Eqs+ c Wc5�- sede3 � �o�� wf�A c�ac� <s
h
How does local government zone the tract?
i Is the proposed project consistent with the applicable zoning?
i CJ e- PgJ'I0. 1
(Attac oning compliance certificate if applicable)
❑NA
es ❑No
I
Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes ❑No
k
Hasa professional archaeological assessment been done for the tract? If yes attach a copy ❑Yes o ❑NA
If yes by whom?
I
Is the proposed project located in a National Registered Historic District or does it involve a ❑Yes TKo ❑NA
National Register listed or eligible property?
<Form continues on next page>

Form DCM MP 1 (Page 3 of 4)
APPLICATION for
Major Developmdnt Permit
m (i) Are there wetlands on the site? [1Y-s ONo
(u) Are there coastal wetlands on the sites 2<es ❑No
(iii) If yes to either (i) or (u) above has a delineation been conducted? ❑Yes ZNo
(Attach documentation if available)
n Describe existing wastewater treatment facilities
.5 c-pfiL c m tq�—
o Describe existing drinking water supply source
0c- I`
p Describe existing storm water management or treatment systems
—/ C> iq m-;P- t4f1 x rt, (- l��z�lti
5 Activities and Impacts
a Will the project be for commercial public or private use? ❑Co ercial ❑Public /Government
nvate /Community
b Give a brief description of purpose use and daily operations of the project when complete
S vN�vI�NQ �t✓ru� 1N� Vcc /`I Sef�S`
A05*c,,y LJ d j e,>- ►4 �3 . � Kam...
Fc> H ► s l� +►r � � � m r
Ac-+ 10%t1cs
4- j Qoc�f ►r
c Describe the proposed construction methodology types of construction equipment to be used during construction the number of each type
of equipment and where it is to be stored )(Zs- M e:fck J 13Q✓`� e u,, +4 k E -1 c -aoa6,,- coq if Aa-P
cQA %v11,t3 t,Pb1e-sI p Z© X r tb"sk 6c-,-Y- o R'M
eUo4 fo mt(vptir 4)4 "e 406l1Ie-
e,o"s1✓\uv4r/Y3 CA0 - A -4%,L tpol e.? Na thc4.4-10 IN II'u /dcce 1 b4,5e 51-<y S
At- 3,4 6,Aick S AV,- -s, e >f
d List all development activities §u propose ,
JL s+ gr-m
e- c(Sf,,g3 kOD - t fz� 0 f fstio,e,
n�,.,D a�acl� �,�-�. �ic, +f.�`w1�
e Are the proposed activities maintenance of an existing projct new work or both? Cori► )4ck-�Yf i 4i�/ cQ �xJSfr 113
iboc.1C j e,9 m- 4)e-1y t-'.0 1" 5-0y" v
f What is the approximate total disturbed land area resulting from the proposed project? ❑Sq Ft or ❑Acres
g Will the proposed project encroach on any public easement public accessway or other area UYes ❑No ❑NA
that the public has established use of7 /o 7A
h Describe location and type of existing and proposed discharges to waters of the state
NoNe-
i Will wastewater or stormwater be discharged into a wetland? []Yes o ❑NA
If yes will this discharged water be of the same salinity as the receiving water? ❑Yes ❑No NA
I Is there any mitigation proposed? ❑Yes ZNo, ❑NA
If yes attach a mitigation proposal
<Form continues on back>
M

Form DCM MP 1 (Page 4 of 4)
APPLICATION for
Major Development Permit
6 Additional Information
In addition to this completed application form (MP 1) the following items below if applicable must be submitted in order for the application
package to be complete Items (a) — (0 are always applicable to any major development application Please consult the application
instruction booklet on how to property prepare the required items below
a A project narrative
b An accurate dated work plat (including plan view and cross sectional drawings) drawn to scale Please give the present status of the
nroposed project Is any portion already complete? if previously authorized work clearly indicate on maps plats drawings to distinguish
oetween worn completed and proposed
c A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site
d A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties
e The appropriate application fee Check or money order made payable to DENR
f A list of the names and complete addresses of the adjacent waterfront (riparian) landowners and signed return receipts as proof that such
owners have received a copy of the application and plats by certified mail Such landowners must be advised that they have 30 days in
which to submit comments on the proposed project to the Division of Coastal Management
Name ThomuS j e,,/&y Phone No Z ?.k6-C)7y7
Address 102. f�:,+ne5t- t),A
Name Le- NCq,) C Phone No
Ci
Address Z j` -f- J 101"\
Name Phone No
Address
g A list of previous state or federal permits issued for work on the project tract Include permit numbers permittee and issuing dates
J3� I KGi��Q G �' / l cc) S7/0,5'-
h Signed consult -int or agent authorization form if applicable
i Wetland delineation if necessary
I A signed AEC hazard notice for projects in oceanfront and inlet areas (Must be signed by property owner)
k A statement of compliance with the N C Environmental Policy Act (N C G S 113A 1 10) if necessary If the project involves expenditure
of public funds or use of public lands attach a statement documenting compliance with the North Carolina Environmental Policy Act
1 7 Certification and Permission to Enter on Land 1
I understand that any permit issued in response to this application will allow only the development described in the application
The project will be subject to the conditions and restrictions contained to the permit
I certify that I am authorized to grant and do in fact grant permission to representatives of state and federal review agencies to
enter on the aforementioned lands In connection with evaluating information related to this permit application and follow up
monitoring of the project
I further certify that the information provided in this application is truthful to the best of my knowledge
Date %oZ 3o r 2 C>Z Print Name (2 04,
Signature C.,L't
Please indicate application attachments pertaining to your proposed project
ODCM MP 2 Excavation and Fill Information ❑DCM MP 5 Bridges and Culverts
❑DCM MP 3 Upland Development
❑DCM MP 4 Structures Information

Form DCM MP 4
TRU CT RE
(O0nstr.JCt10n 1113thin Public Trust Areas)
Attach this form to Joint Application for LAMA Major Permit Form DCM MP 1 Be sure to complete all other sections of the Joint
Application that relate to this proposed project Please Include all supplemental information
1 DOCKING FACILITY /!MARINA CHARACTERISTICS
a (i) Is the docking facility /marina
❑Commercial ❑Public /Government Private /C.ommunity
❑ This section not applicable
b (i) Will the facility b en to the general publics
❑Yes o
c (i) Dcck(s) and /or pier(s) d
(i) Are Finger Piers included? []Yes QNo
(n) Number I
If yes
(m) Length r%Y
(u) Number
(iv) Width
(m) Length
(v) Floating [:]Yes 2<0
(iv) Width
(v) Floating ❑Yes []No
e @ Are Platforms included? { Yes ❑No f
(i) Are Boatlifts mcluded7 e
If yes
�
If yes
a
(n) Number i I� �x %�I S� �`�
(n) Number
(m) Length -3 E
j 1 7ht 4f X �� ���i 6�c
(m) Length 3`
�
i3
iv
() Width E G�
C u f�-
(iv) Width
(v) Floating []Yes []No
Note Roofed areas are calculated from dnpline dimensions
g (i) Number of lips proposed h
- R,--1vL,4ed
Check all the types of services to be provided
a 7cffml 0140 Hc-c� euz
❑ Full service including travel lift and/or rail repair or
(ii) Number of slips existing
maintenance service
❑ Dockage fuel and marine supplies
—L
❑ Dockage ("wet slipsl only number of slips
❑ Dry storage number of boats
❑ t ramp(s) number of boat ramps
Other please describe
i Check the proposed type of siting j Describe the typical boats to be served (e g open runabout
❑ Land cut and access channel OA-44 boats sail boats mixed types)
❑� n water dredging for basin and/or channel �4 �L �N��C,� ^s i" A6' eo.5 ����"^
LvJOpen water no dredging required 2 OQclrnKe,/-
❑Other please describe
k Typical boat length �0 1 (1) Will the fac�ility open to the general pubiic'2
❑Yes DdNO
m (i) Will the fa^ have tie pilings9
E]Ye! eNo
(ii) If yes number of tie pilings)
252 U4 -23')3 1 N +�, I' nos' 7 :aviis-d 3221 ,CZ

a Check each of the foiloNing sanitary facilities that Ndl be included in the oroposed prolec
❑ Orice Toilets
❑ Toilets For patrons Number Location
❑ Showers
❑ Boathold ng tank pumpout Give type and location
b Describe treatment type ano disposal location f-, all sanitpry Nastewater
C Describe the disposal of solid waste fish offal and trash
d How will overboard discharge of sewage from boats be controlled*7
e (i) Give the location and number of No Sewage Discharge signs proposed
(u) Give the location and number of Pumpout Available signs proposed
This section not appricame
I Describe the special design if applicable for containing industrial type pollutants such as paint sandblasting waste and petroleum products
g Where will residue from vessel maintenance be disposed of?
t
h Give the number of channel markers and No Wake signs proposed
i Give the location of fuel handling facilities and describe the safety measures planned to protect area water quality
1 What will be the marina policy on overnight and live aboard dockagel
k Describe design measures that promote boat basin flushing?
1 If this project is an expansion of an existing marina what types of services are currently provided?
�, r�v3s 3t! 122700
a -32 80a V %03 3- $.'�£t- = CG�+aT -v4rrr -,ac a,rAar IS -neti n�t

r^ is he mG ��ra, �docvnr facility ,roposed Nithin a ,rirrary or secordar/ nursery ar a1
❑Yes I-No
Is the mar raidgnk g acilit/ nrcposed i h n or ar lacent o nj shellnsn harvesting area?
❑Yes (�Kjo
o Is ha ma ra/deckmg °ac lhty proposed Nthin or ad acent o oastal wP ands marsh (CVI) submerged aqua is vegerat on (SA /) sned cot'om
(SB) or other wet and /L)? If any boxes are checked provide the number of quare eet affected
[jcW AV ❑SB ,] - `
❑None /try C C 51 ��"
p Is he propcsPd ma ina/docking facilily located Nithin or within close pro imity to any shellfish leases? ❑Ye L✓N0
If yes give the name and address of the leaseholder(s) and give the proximity to the lease
,3 BOATHOUSE (including covered lifts) rs section not applicable
a (i) Is the boathouse structure(s)
❑Commercial ❑Public/Govemment ❑ Private/Comm unity
(u) Number
(m) Length
(iv) Width
Note Roofed areas are calculated from drnpline dimensions
4 GROIN (e g wood sheetp►le etc If a rock groin use MP 2 Excavation and Fill) _ ►s section not applicable
a (i) Number
(u) Length
(w) Width
5 BREAKWATER (e g wood sheetp►le etc) I r 2T ►s section not applicable
a Length b Average distance from NHW NWL or wetlands
c Maximum distance beyond NHW NWL or wetlands
6 MOORING PILINGS and BUOYS h v - 21 his section not applicable
a Is the structure(s) b Number
❑Commercial ❑Public/Government ❑ Private/Comm unity
C Distance to be placed beyond shoreline d Description of buoy (color inscription size anchor etc )
Note This should be measured from marsh edge if present
e Arc of the swing
d�2 -E08 -2305 I 333-- zZ:?3,oi -mot me t-S 3jr^;nnacic �r^a-It r�4 r- iaad IZ2' L,j

7 GENERAL
a Pr4o amity of structure( ) to adjacent riparian property lines
5' r f ol� o -`&..e a y Cc,, t' mic.sf- 5 ,fie
Mote For buol or mocring piling use arc of s Ntng including length
of vessel
c Width of eater oody
--L L12 M e� ()n u>/
e (i) Will nangational aid required as a result of the project?
❑Yes []No VNA
(u) If yes explain what type and how they will be implemen ed
8 OTHER
a Give complete description
-lYie:.w— /.5 oc
o 0 r4
b Proximity oi truc ure( ) to adlacent dcc <rg ac li+ies
A4- -S-0y"
hsSe. Si4 0 b"A- -7-0 M o Lyi4 3 ro 0 ,& ft F—M C
cx s 4- o F 4 �o ,Po s-e d-0-_
d Water depth at wateraard end of struc ure a00r NWL
S'
P
No
+ d-ec occt5 -e 5
[]This section not applicable
Sfoe�iA
wo -lej— A /Sa
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" CX
Date
Project Name
CiOLv-- ( E - W6-tfue-
ApglLcant Name &� evil
( )Q&.,
Applicant Signature
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