69156D - Ard

TiCAMA /-'®iREDGE & FILL P�
-�.3�1% A B C' pD
GENERAL PERMIT Previous permit #
�Iew Modification __Complete Reissue El Partial Reissue Date previous permit issued
Asauthorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC�n
Rules attached
Applicant Name }�,^� �� Project Location: County y' _ l�
Address - l� Street Address/ State Road/ Lot #(s)
City State ZIPJ
Phone E-Mail Subdivision t I' n
Authorized Agent City V ZIP a� `"l tX`>
Affected ❑ CW ElEW El PTA ES ElPTS Phone # ( ) River Basin
AEC(s): VOEA ❑ HHF ElIH ElUBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes /(40�
Type of Project/ Activity
Pier (dock) leneth
Fixec
Float
Fingt
Groii
Bulkl
Basin
Boat
Boatl
Beacl
Othe
Shon
SAV:
Mora
Phou
Waiv
Adj. Wtr. Body -1 man unkn
Closest Maj. Wtr. Body
ll
(Scale: 1 � )
i length
number
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■■■■■■■■�■■■■■■■■■■■®■■■■■■r�■tom■■■OVENE
■■■i
■■■W�J�
L�■�■1�1111['!!�I��i�f
��lt►'.!'�►■�1■■■■■
�l�l�Ili■■■■
OEM
■t�
��if`w�il�
.line■OWNSnot sure yes
IYlmi1��7■fl!■■■�■■■�■■■■■■■
MEMNON
0069!170"
ks: yes® ►'►emin
0■■■oiv�.■��■■■■■■■■■■■■r
�■■■■
MM
Attached: yes
■■Ramm■■■
_
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A building permit may be required by:
( Note Local Planning Jurisdictioti�
Notes/ Special Conditions �1 1
nt Printed Name
LA
11
❑ See note on back regarding River Basin rules.
0
Qnaadrr l *'t Please read compliance statement of n back of peerrm�iit"
Check #
4-4

NC Division
Applicant: PP �r
A-4
Date:1�
Ilg
Describe below the A I A disturbances for the application.
of Coastal Mgt. Habitat Impact Computer Sheet
#F f o6 1sLv
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact
temp impacts
amount)
Dredge ❑ Fill ❑ Both ❑ Other
�ju
"amount)
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Apr 24 2017 07:22AM HP Fax
page 3
AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Prope4 Owner Requesting Permit: 4
Mailing Address: f1c1 ex x �U a
PQ n,tt Itch 'C,, :j cls 3
Phone Number:
Email Address: Avd5r- 6C4, cLAO f cc /Z,r
I certify that I have authorized Jn✓,,e L &c ?lV
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Scat ct
G- C.ta + .i✓cb e d 4,J -V
at my property located at (,,:) 7 E ,B e cb PI 1 V E t0k- a la �,rr' ti C-' ,
inCounty.
l furthermore certify that 1 am authorized to grant, and do in fact grant pennission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter

CAMA MINOR PERMIT PROGRAM
❑ MODIFICATION ❑ EXEMPTION ❑ MAINTENANCE AND REPAIR
Town of Oak Island
CAMA Minor Permit Office
As authorized by the State of North Carolina
per the Coastal Area Management Act of 1974
Applicant Name_ 5�,.,,� Ate0
Address 36 3
City P4�pt s� a5� 03
Phone #
Authorized AgentJ�-L�U,,J��
Type of Project
Description of Activity:
UDC C<r'Ve L'J
Z C S4 c'a• d r �,�
Notes or special
conditions: Cost of project.
Permit #
Date previous
permit issued
Project Location Information
Street Address_ L/Q, -9
mat/. �4� ✓U(
Adj. Water Body—dL-4 i,( Or,�
AEC: ❑ CS EZ OE ❑ HH ❑ IH
O2
SITE DRAWING
;Owne ' Name (Print)LPO S�`��4 natu (owner or agent)
lasuance Date
Exp, Date
OAK ISLAND DEVELOPMENT SERVICES - 4601 E. OAK ISLAND DR. — 910-278-5024

9SE4 hE90 0000 Oh22 9204
2hE8 hEBO OOOo Oh22 92Oz