72725D Lilley

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
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gig -aqi -5-7o
Clt;ltP_'fpc'ca Q nC_' .`C,(.for,
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Lf
at my property locat,
at
County.
l furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Propeer Information:
Signature
o� Print or Type Name
Title
Date
This certification is valid through 1

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: e a n
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions mint be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact Information for DCM offices is
available athttA://wNi,v.nccoastalmanauementnet/web/ --staff-fistingorbycalling 1-888-4RCDAST.
No response ►s considered the same as no oblecdo-n If you have been noted by Certified Mari
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' 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 wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(P P O er In r scion)
Si ture ;
Print or ype Name j
Mailing Address
4Q49/Sata(�tSa-C,00p,
sr6 7
dlil%, A1�Vc,AR. Cco,
Telephone Address
Date
(Riparian Property Ow er Information)
Signature
yL►tri
Pnnt or Type Name
Mailing Address
G\\X,A , ,
City/State;5p
g1w990-Z%'�R ChAAC'triha 0PM�a�gmai1. COM
Telephone Number IEmaiJAddiess D
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property: � 1-6 lje-S� J CAGE► n r r) a k Ls 1ANd
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) In writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at hifA://wwi.v.nccoastalmanapement net1web/cm/staff-/istinp or by calling 1-888.4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(P pe 70;er In r ion)
Signdture
r �
Print or ype Name
y500 (") : kil-k t'►wM C�
Mailing Address
U ) Ake Eae5� Z?s167
Q66State/Zip
�J19-Z l-Sl7D ��i�%� A1�Nc,iZRCcy„
Telephone Nu ber ' Emai Address
Date
(Riparian Property Owner Information)
Si ttire
<T -Mes n, k� a re (� C�.
Print or Type Name
6110 PtVei' cA>unA Cir
Mailing Address
(So46 VO4 t s c. a-S L (1
City/Stat ip
919- L402-- 2-ZS5
Telephone Number/Email Address , cDwt
Date
(Revised Aug. 2014)

CAMA EMERGENCY GENERAL PERMIT
INFORMATION
Town of Oak Island
CAMA Permit Office
As authorized by the State of North Carolina
per the Coastal Area Management Act of 1974
Applicant NamebA.q ( r,-z �� �1 0--L.
Address 466��o.,r,-�
city W"-Q— I W— &-75S-7
Phone # 'I I l - a9 � - Si ID
I Authorized
Type of Project
Description of Activity:
Cost of project:
Notes or special conditions:
I
et
Owner`(P t)
Signature owner or agent)
Permit #
Project Location Information
Street Address_�3 W . b-a c T-X,-/L
DQ k I ► o-y�
(Adj. Water Body
[AEC: ❑ CS ❑ OE ❑ HH ❑ IH
LPO Signature
Waaace Date Exp. Date
OAK ISLAND DEVELOPMENT SERVICES - 4601 E. OAK ISLAND DR — 910-278-5024