49127D - Beam

AMA / ❑ DREDGE & FILL 4
k�� `� �l
NERAL PERMIT Previous permit #
W ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
by the State of North Carolina, Department of Environment and Natural Resources /] -�
;oastal Resources Comm fission in an area of environmental concern pursuant to I SA NCAC
❑ Ru1 s attached.
t Name �\ Project Location: County 4V '"V
11YQ Street Address/ State Road/ Lot #(s) "A 27
1 StateNQ ZIP 01'gO
( ) 1 Fax # O Subdivision
ed Agent (-'Eity l c, ZIP
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin -16 L'I
LEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
❑ PWS: ❑FC: �
yes / no PNA yes / o Crit.Hab. yes / no Closest Maj. Wtr. Body
Project/ Activity
i
ck)length
ngth
nber
V Riprap length
distance offs
x distance o h
cannel
)ic
1p
se/
Aldozing %
Length
notsure yes
>: not sure yes L
ium: n/a yes L
yes
\ttached: yes I
ig permit may be required by: 1
-A
a-0
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(Scale: `1!
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1 X ���o� ❑ See note on back regarding River Basin n

iG Division of Coastal Mgt. Habitat Impact Computer Sweet
pplicant:
ate: UUU "�ffMMM
Permit #: q01 I a;nt
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
fund in your Habitat code sheet.
abitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fin
disturbance.
Excludes any
restoration and
temp impact
amount)
Dredge [IFill ElBoth [IOther
J V
60"'J
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [I Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: � f4
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
NO
County.
l furthermore certify that 1 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.
Property Owner Information:
Signature
Print or Type Name
Title

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Jame of Property Owner:
kddress of Property: 312-7 6
,gent's Name #:
,gent's phone #:
or Street #, Street or Road, City & County)
Mailing Address:
hereby certify that I own property adjacent to the above referenced property. The individual
Dplying for this permit has described to me as shown on the attached drawing the development
iey are p posing. 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.
you have objections to what is being proposed, you must notify the Division of Coastal Management
►CM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
,ailable athttp://www.nccoastalmanagementnet/web/cm/staff-listing orby calling 1-888-4RCOAST.
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
mderstand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
u 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.
•operty Owner Information)
nature
it or Type Name
(RipariagAProperty Owne n r ation)
Signature
Print or Type Name
ling Address
Mailing Address A

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:'
Address of Property: �/w tid
(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.
J p p
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 http://Www.nccoastalmanagement netlweb/cm/staff-listinq 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.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
(Ri avian Propert ;wner Information)
J� I�
Si tune y
[d U Y ��
Print or Typb Name
17��tCtrl�c�re d-�ctce ..
Mailing A ddres

-Pherson, Tara
n: Kim Painley <[e-mail]>
t: Monday, November 07, 2016 5:46 PM
MacPherson, Tara
ject: Fwd: sand -pushing
is Judy's permission for me to sign the permit for 3927.
se email me the permit when it is ready, and I'll send it to the contractor.
iks! Kim
from my iPhone
n forwarded message:
From: "Judy Beam" <[e-mail]>
Date: November 7, 2016 at 5:10:51 PM EST
To: <[e-mail]>
Subject: sand -pushing
I, Judy Beam, give Kim Painley permission to sign my name to required form for sand -pushing operation
at 3927 West Beach Dr. Oak Island, N. C.

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