20170653 Ver 1_Shellfish Lease Application_20170525

North Carolina Shellfish Lease Application
RECEIVED
MAR of
Habitat &Enhancement
1. Primary Applicant Information: *(Fill this out if applying as an individual)
Applicant: First Name
MCI
Last a e
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Race: t�, Gender: Male • ❑ Female
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Height: S' ICt" Weight: 7. Eye Color: ��.� Hair Color: 1.Sivi
Have you been a legal resident of the state of North Carolina for at least 6 months? ❑ No ❑ Yes
Check One:
Driver's License No.9 State I.D. No. ❑ Military I.D. No. ❑ Resident Alien I.D. No. ❑ Passport No. ElNumber:
1 Expiration Date: a
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Are you related by blood or marriage to any person now working for the North Carolina Division of Marine Fisheries? M No
❑ Yes: Name and Relationship
Do you hold a Standard Commercial Fishing License? N No ❑ Yes: SCFL #
Do you currently own a vessel with current registration? ❑ No K Yes: Vessel ID# C. D 2
Do you have four or more convictions of DMF fisheries violations in the past three years?&] No ❑ *Yes -
*(If Yes you may not be eligible to obtain needed permits to work a lease other than cultch on bottom)
Do you currently have or hold an interest in any other shellfish leases? X No ❑ Yes
List lease numbers you hold or have an interest in:
G.S. 113-202 (c): No person, including a corporate entity may acquire and hold by lease, lease renewal, or purchase more than 50
acres of public bottoms under shellfish cultivation leases. For purposes of this subsection, the number of acres of leases held by a
person includes acres held by a corporation in which the person holds an interest.
Applicant Mailing Address
91r
PO Box
City
State
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Applicant Physical Address
City
State
Zip code
Daytime Phone No
Alt. Phone No
Email address
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Co -Applicant: First Name
MI
Last Name
Have you been a legal resident of the state of North Carolina for at least 6 months? ❑ No ❑ Yes
Check One:
Driver's License No. ❑ State I.D. No. ❑ Military I.D. No. ❑ Resident Alien I.D. No. ❑ Passport No. ❑
Number: Expiration Date:
Are you related by blood or marriage to any person now working for the North Carolina Division of Marine Fisheries? ❑ No
❑ Yes: Name and Relationship
Do you hold a Standard Commercial Fishing License? ❑ No ❑ Yes: SUL #
Do you currently own a vessel with current registration? ❑ No ❑ Yes: Vessel ID#
Do you have four or more convictions of DMF fisheries violations in the past three years? ❑ No ❑ *Yes
*(If Yes you may not be eligible to obtain needed permits to work a lease other than cultch on bottom)
Do you currently have or hold an interest in any other shellfish leases? ❑ No ❑ Yes
List lease numbers you hold or have an interest in:
Version: DMF Lease App 2/2017

Page 2 of 16
Co- Applicant Mailing Address
PO Box
City
State
Zip code
Daytime Phone No
Alt. Phone No
Email address
2. Business Entity Information (Article 16 of Ch. 113): *Fill this out if applying as a Business Entity
Business Name
Type of Business Entity:
❑Corporation (Please attach copy of current articles of incorporation and list of corporate officers)
❑Partnership (Please attach a current copy of your partnership agreement)
[]Sole Proprietorship
DkLLC
* Please attach copies of the Articles of Incorporation, current assumed name statements, and copies of current business privilege
tax certificates with Employer Identification Number (EIN) listed.
Business Mailing Address
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PO Box
City 1
State
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Zip code
LI
Daytime Phone No
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Alt. Phone No
Email address
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Business Party Name:
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Business Ant Mailing Addres
PO Box
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State
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Zip code
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Daytime Phone No
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Alt. Phone No
Email address
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Are you related by blood or marriage to any person now working for the North Carolina Division of Marine Fish es? ❑ No
❑ Yes: Name and Relationship
Do you currently have or hold an interest in any other shellfish leases? PC No ❑ Yes
List lease numbers you hold or have an interest in:
G.S. 113-202 (c): No person, including a corporate entity may acquire and hold by lease, lease renewal, or purchase more than 50
acres of public bottoms under shellfish cultivation leases. For purposes of this subsection, the number of acres of leases held by a
person includes acres held by a corporation in which the person holds an interest.
3. Applicant Qualifications (Optional) -describe your capability to conduct the proposed aquaculture activities
(including training, experience and education that you have obtained or will obtain)
Version: DMF Lease App 2/2017

Page 4 of 16
4. Proposed Lease Site Information
Check one that you are applying for: *The designated, nonrefundable application fee must accompany each application.
Bottom Lease ($200.00): A bottom lease primarily uses cultch, or low profile structures to cultivate shellfish. Cages
and gear are limited to a maximum height of 18" above the bottom. Rent: $10/acre per year.
❑ Water Column Amendment ($100.00): A water column lease amends all or part of an existing bottom lease footprint.
Floating bogs, cages greater than 18" above the bottom or any other use of the water column will require this type of
lease. Rent: $100/acre per year.
❑ BOTH Bottom Lease with Water Column Amendment ($300.00): This lease is a joint application for both the bottom
lease and water column amendment. Rent: $110/acre per year.
Lease Cou:
Closest '�Tppwn:
Waterbgdy:
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Estimated total acreage: Note: Acreage allowed must be consistent with the Leasb Management Plan, prior lease
production history, public trust use of the area, etc.
Single lease acreage is currently
limited to 10 acres in areas where
oyster mechanical harvest is allowed.
All other areas limited to 5 acres.
Does the lease site contain known sea grasses or Submerged Aquatic Vegetation (SAV)? No ❑ Yes
Leases are restricted on sites with areas of SAV.
Approximate closest distance to existing shellfish bed or oyster rock? 10 ft.
Leases must not be located on or within 10 ft. of existing natura! shellfish beds or oyster rocks or seagrass beds.
Approximate distance to marked navigational channel ( ),00 ft.
Approximate distance to any unmarked navigational channel 4IS2> ft.
Leases cannot block navigation.
Does the applicant or co -applicant own all of the shoreline adjacent to the proposed lease?* 1K1 No ❑ Yes
If the applicant or any co -applicant is not the sole riparian owner of any developed shoreline within 100 ft. of the proposes lease, the
riparian consent form in Section 6 of this application must be filled out and notarized to proceed with application processing.
Riparian property owners will be notified of your proposed lease site.
Approximate minimum distance of proposed lease from shoreline 60 ft.
Approximate minimum distance of proposed lease from vegetated marsh an ft.
Please list the coordinates for the proposed lease. The minimum number of coordinates required is three and the maximum is
ggt t: A survey is not required by law but is suggested as a best management practice. Any costs of a survey are the responsibility
of the lease holder. The lease site must be as compact as possible.
Corner Coordinates:
1. ray.>0(o N,_n-7-6161" W 5. 3ci•�J(otl�[U-T N."�7%. 6'7 CSC 55 W
0'4.i(o�(UG3 N,—7'A36.54.-107 (Si N, —77. 75YOW
3. N, --7-7. L-1 Go W 734.3L 3-) cT3 N, --77.G-75Y�� W
4.i 1.U%y 0 N,44W 8. N, W
Version: DMF Lease App 2/2017

Page 6 of 16
5. Lease Management Plan
Shellfish species to be grown: oysters ❑ Clams ❑ Scallops Other fn 5W 115,
wss,bky .
Capital Investment: Year 1: $ 5ZY6 Year 2-5: $
Vessel Available: Vessel: ❑ N 0Y Length: Power: H
hTrailered? ❑ N [$Y
If other vessels will be used, please list hhere:
17' rrAIrDki 01 �tl�
• What types of harvest gears will you use? nini6Ca�(•� klc S
^power
• Will you require the use of mechanical harvest gear? (dredge rake,
etc.) fW N ❑ Y
*Mechanical gears are not allowed on leases located in Primary Nursery Areas
Shellfish Grow -out Method: Please check the grow -out method(s) you propose to
use on your lease and the estimated amount of
equipment and effort.
*Bottom Leases are restricted to 18" maximum height unless otherwise conditioned in the lease contract.
Bottom Methods Years 1-3
Years 4-5
DQ Cultch on -bottom only bushels/acre
_� bushels/acre
❑ Spat-on-shell/clam seed spat/seed/acre
spat/seed/acre
91 Relayed oysters (Polluted or seed oyster bushels
61,0_ bushels
relay sources)
❑ Predator netting/bags # of units
# of units
❑ Rack and bag system # of racks/bags �_
# of racks/bags
Cage system # of cages I m Y
# of cages Com•
❑ Tray culture # of trays
# of trays
❑ Other: Specify
Specify
Water Column Methods Years 1-3
Years 4-5
❑ Floating bags (Taylorfloat'", # of floating bags _
# of floating bags_
mesh bags, flip bags, etc.)
❑ Floating cages (Oyster Gro'", etc.) # of floating cages
# of floating cages
❑ Suspended system, long line # of units
# of units
❑ Rack and bag system >18" # of racks/bags /_
# of racks/bags
❑ Bottom Cage system >18" # of cages
# of cage s
❑ Type of Anchor used (screw anchors, rods, Type
Type
etc.) # of Anchors
# of Anchors
❑ Other:
Shellfish seed source:
Do you plan to participate in the following permit relay DMF activities?
(Circle all that apply)
IX Polluted Area Relay
C9 Yes ❑ No
*Only shellfish native to NCmoy be
❑ Seed Oyster Mgt. Relay
❑ Yes A No
cultured. Shellfish seed obtained
In-state hatchery: Hatchery Name:
w' k Poo 0y 5y o --t,
from outside of NC will require an
❑ No IN Yes Phone No: Gi
Introduction of Species or Transfer
Out of state hatchery* Hatchery Name:
11"JA
Permit from DMF prior to shipment.
Address: 'j �;
� Nov .
This permit application must have a
El No WYes City: C.V-pyU,
°
pathology report attached and is
State: SL_
Zip Code: 7uqA'-lb
goodfor 30 days after the report
Phone No:
4''j��i—(5
date.
Version: DMF Lease App 2/2017

Page 7 of 16
5. Lease Management Plan (continued)
Planting/Seeding Dates and Expected Harvest:
Planting dates Year 1 )u ^ P (month)
Expected first harvest date: P�a-o�- Expected yield per acre: yO• bushels; or q
Do you plan to harvest oysters anytime during April —September? ❑ No rXYes
Will you operate as a Shellfish Dealer? Iii No ❑ Yes
*Closed oyster season harvest requires a Closed Oyster Harvest Certification, A Shellfish Dealer must have o Certification from
Shellfish Sanitation [phone], and a DMF Dealer License to operate.
*A Commercial Fishing Vessel Registration will be required annually for boats used to harvest or transport seafood. The registration
is separate from the NC Wildlife Resource Commission's registration.
Lease Marking
Type and number of markers to be used
Lease corners must be marked and proper durable
❑ Wood post (3-4 inch) #
signage attached including all lease numbers,
9L Plastic/PVC dia. 3 # 7
reflective tape, and the name of the leaseholder.
❑ other (composition and dimension):
Water Column leases must also have yellow floats
#
marking each corner. Boundary markers should be
every 150 feet.
*Markers greater than 4x4 inches may require a permit from the Division
of Coastal Management.
NOTE: Leases may be conditioned to reduce or
increase the number of markers required depending
#The DMF has no duty to protect any lease or franchise that is not
upon location, navigational issues, etc.
properly marked.
Land/Dock Based Facilities: (check all that apply) ❑ Raceway/trays
❑ Dock ❑ Graders/Sorters
❑ Floating Upweller ❑ Tumblers
❑ Tank Upweller or Downweller ❑ Storage facilities, sheds, etc.
❑ Pumps ❑ Other: (specify)
* NOTE: These structures, if proposed, may require
a permit from the Division of Coastal Management
Lease Cleanup Provisions
*If your lease is surrendered, cancelled, terminated for lack of production or failure to pay rent, or you simply choose to relinquish
the lease, the leaseholder is responsible for removing all markers, posts, and aquaculture gear except planted cultch. You will be
given a 30 -day notice to remove all posts, markers, and aquaculture gear. If you do not remove the markers, posts, and gear after
the 30 -day notification, the Division of Marine Fisheries may pursue legal action to have it removed at your cost. These provisions
will be included in the lease contract.
The leaseholder is also responsible for collecting any gear that is displaced due to storm events. It is highly recommended that all
lease equipment is labeled with your contact information to facilitate collection in case of storm loss.
By signing I agree that I have read and understand the Lease Cleanup Provisions:
3/b I1-7
Signature: !
/j Date:
For Staff Use Only: Aquaculture Permits needed for described lease management plan:
❑ AOP ❑ ACP ❑ ASTP ❑ Intro ❑ Mechanical Harvest ❑ Polluted Area Relay ❑ SOMA
Version: DMF Lease App 2/2017

Proposed Lease Site Diagrams #1
LOCATION MAP: (Insert below or on a separate piece of paper)
tiI OCC
C'�.cJPS
Version: DMF Lease Apr
Page 9 of 16
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1

Proposed Lease Site Diagrams #3
SIDE VIEW DIAGRAM (insert below or on separate piece of paper)
Version: DMF Lease App 2/2017
Page 13 of 16
M (V,/

7. Consent Form for Riparian Property Owners
I/We, the undersigned, hereby give my/our consent to (Name)
who resides at (Physical Address:)
to lease:
❑ Shellfish bottom
❑ Shellfish bottom and the water col n
within 100 feet of my/our shorelin . n
Signature
Signature
Street Address or PO Box City
SWORN to and subscribed before me
This the
My Commission Expires:
of
NOTARY PUBLIC
Version: DMF Lease App 2/2017
20
Print)
Name (Please Print)
State/Zip
Phone
Page 14 of 16

Page 16 of 16
9. Final Signature
By signing below, the Applicant hereby states that the information included in the application is true and correct, and
that the Applicant(s) understand the following:
1. The Applicant will accept the lease or franchise subject to all the provisions of the North Carolina Marine Fisheries
Commission Rules and applicable General Statutes 113-201, 113-202 and 113-202.2.
2. The annual Lease rental fee shall be $10.00 per acre for bottom leases and $100.00 per acre for water column leases.
Lease rent is prorated for the first year, and is due prior to the issuance of the lease contract. Annual rent shall be paid a
year in advance on or before March 31. Unpaid or delinquent rent will result in the termination of the lease.
3. The applicant agrees to use the lease for commercial production of shellfish and shall provide annual production
reports as required by the division. Failure to meet production requirements may result in the termination of the lease.
Applicant Name:�!e•`
Co -Applicant:
OR
Business Agent: p s(.,) I n t` At -i
SWORN to and subscribed before me
This the day of /-71 ,, rc 20
j NOTARY PUBLIC
My Commission Expires:
Version: DMF Lease App 2/2017
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