20170661 Ver 1_401 Application_20170530

ECEt
CPage 1 of 16
North Carolina Shellfish Lease Application -----------
Enhancers,
1. Primary Applicant Information: *(Fill this out if applying as an individual)
Applicant: First Name
MI
Last Name
Zaftn
A
IMw(rl-s
Race: Gender: 'Male L1 Female
p
Height: t t' Weight: 230 1� Eye Color: Gree,,, Hair Color: Rem(
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: L Expiration Date: ro /1 2022
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 les: SCFL # "! :o
Do you currently own a vessel with current registration? 11No es: Vessel ID# N4, -1 u ( FD
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 es
List lease numbers you hold or have an interest in: fl' SW2( &IM Wb�y,� MpFf!i ,
G.S. 113-202 (c): No person, including a corporate entity may acquire and hold by lease, lease renewal, or purchase more than SO
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
PO Box
City
State
Applicant Physical Address
City
.State
2Z3 wI 14(l
See lova{
NL
Zip code
Daytime Phone No
Alt. Phone No
Email address 'A
U5 -1
a5a-342-1452
YNill lit u�c�Lf%r��o�Mail,cowt—�
Cpplicant: First Name MI
Last Name
Have you bee a legal resi�nt of the state of North arolina for at least 6 months? El No 11 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 ora riage toy y person now working for the North Carolina Division of Marine Fisheries? El No
1 Yes: Name and Relationship //
Do you hold a Standard Commer�1c�hmg License? ❑ No ❑ Yes: SCFL #
Do you currently own a vessel ith curve registration? ❑ No ❑ Yes: Vessel ID#
Do you have four or more/ evictions of DM 'sheries violations in the past three years? ❑ No ❑ *Yes
*(If Yes you may not be igible to obtain neede Nrmits to work a lease other than cultch on bottom)
Do you currently hv6or hold an interest in any othe hellfish leases? ❑ No ❑ Yes
List lease numb you hold or have an interest in:
lersion: 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
❑ LLC
* Please attach copies of the Articles of Incorporation, current assumed name statements, and copies of current business privilege
tax certificates with Employer Identification Number (ON) listed.
Business Mailing Address
PO Box
City
State
Zip code
Daytime Phone No
Alt. Phone No
Email address
Business Agent/Responsible Party Name:
Business Agent Mailing Address
PO Box
City
State
Zip code
Daytime Phone No
Alt. Phone No
Email address
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 currently have or hold an interest in any other shellfish leases? ❑ 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 on 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)
-t ru e ��, ��� h�� .� , ����'�kAa
cAkv^�,f OV4� t
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 ajoint application for both the bottom
lease and water column amendment. Rent: $110/acre per year.
Lease County:
Closest Town:
Wat bo
y:
v erg
G
OA I
Estimated total acreage: Note: Acreage allowed must be consistent with the Lease Man gement 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 Ckles
Leases are restricted on sites with areas of SAV.
Approximate closest distance to existing shellfish bed or oyster rock? A Ji lk ft. xf b0bo `ege,
Leases must not be located on or within 10 ft. of existing natural shellfish beds or oyster rocks or seagra s be s.
Approximate distance to marked navigational channel 1000{— ft.
Approximate distance to any unmarked navigational channel I COD r-- ft.
Leases cannot block navigation.
Does the applicant or co -applicant own all of the shoreline adjacent to the proposed lease?* 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 yourproposed lease site.
Approximate minimum distance of proposed lease from shoreline ft.
Approximate minimum distance of proposed lease from vegetated marsh ft.
Please list the coordinates for the proposed lease. The minimum number of coordinates required is three and the maximum is
eight: 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: S, !') 1'_ y�\ I-eczs�� q�l p (� &00 J AJ4
1. N, W 5. N, W
2. N, W 6. N,_W
3. N, W 7. N, W
4. N, W 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
Capital Investment: Year 1: $ u Year 2-5: $ �� t%D) li
Vessel Available: Vessel: ❑ N I Length: Power: Trailered? ❑ N fd'Y
If other vessels will be used, please list here: d 3 - 0
• What types of harvest gears will you use? 2 1,10 Ut }
• Will you require the use of mechanical harvest gear? (dredge, power ra e, etc.)X N ❑ Y
*Mechanical gears are not allowed on leases located in Primary Nursery Areas
lease and the estimated ami
Shellfish Grow -out Method: Please check the grow -out method(s) you propose to use on your
equipment and effort.
to 18" maximum height ur
*Floating Upweller Systems (FLUPSYs), tank downwellers, upwellers, raceways, etc... are restricted
otherwise conditioned in the lease contract.
Bottom Methods Years 1 Years 2-5
EJCultch on -bottom only bushels/acre bushels/acre
❑ Spat-on-shell/clam seed spat/seed/acre spat/seed/acre
❑ Relayed oysters (Polluted or seed oyster bushels bushels
relay sources)
❑ Predator netting/bags # of units # of units
E3 # of racks/bags �_ # of racks/bags
Rack and bag system # of cages # of cages
EJ Cage system # of trays # of trays
❑ Tray culture Specify Specify
❑ Solar Floating Upweller
Dimensions: Material:
How is it anchored to the lease:
Water Column Methods Years 1 (/tl� Years 2-5
Floating bags (Taylor float'", # of floating bags _ if 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
# of racks/bags �_ # of racks/bags
❑ Rack and bag system >18"
# of cages It of cage s
❑ Bottom Cage system >18"
Type Type
❑ Type of Anchor used (screw anchors, rods,
# of Anchors # of Anchors
etc.)
❑ Solar Floating Upweller
Dimensions: Material:
How is it anchored to the lease:
Shellfish seed source:
plan to participate in the following permit relay DMF activities?
(Circle all that apply)
olluted Area Relay ❑ Yes XNo
*Only shellfish native to NC may be
d Oyster Mgt. Relay ❑ Yes No _
cultured. Shellfish seed obtained
In-state hatchery: Hatchery Name:
Fee
from outside of NC will require an
Yes Phone No:
Introduction of Species or Transfer
state hatchery* Hatchery Name:
Permit from DMF prior to shipment.
Address:
This permit application must have a
❑ No ❑ Yes City:
pathology report attached and is
State: Zip Code:
good for 30 days after the report
Phone No:
dote.
Version: DMF Lease App 2/2017

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:
Co -Applicant.
No
Business Agent:
SWORN to and subscribed before me
This the —(9-- Lday of 20 1-7
NOTARY PUBLIC
My Commission Expires: c/ �a I
Version: DMF Lease App 2/2017
Date:
Date:
Date:

Proposed Lease Site Diagram #1
Location map
Nelson Bay
North
Proposed water column
amendment. Existing bottom
lease 9510.
J
4.

Top View Diagram
-
Proposed water column
amendment. Existing bottom K4emh
(—|
lease
N�
North
Oyster flip bags
loot drawn mscale)
�
' /

Side View Diagram
9115111fflil
Mean Low Water (MLW)
Oyster flip bags
4— Shallowend Deep end —►