67103D - Brooks

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M
NERAL PERMIT � � Previous permit #
❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 7 !!/
.oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC oq 1. y6b 2S(30
( n 2 ❑ Rules attached.
t Name b�Gt r I S tN. 1_ �r7„S�C. Project Location: County &Ix., L . �• C. s:
2 3q 5 inlStreet Address/ State Road/ Lot #(s)
State � C ZIP
' () Z 3 1 - y SG -Mail Subdivision �'-
City
ed Agent
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
*EA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes t no PNA yes no
ZIP
Phone # ( ) River Basin Lmv, i�
Adj. Wtr. Body rat ( a Yt� C_ bat
Closest Maj. Wtr. Body !'# (a V1; C
Project/ Activity .� 1r 1; i Z .1,1p 40 \-V (x`C A 4-c ckhr—(
(Scale:
ck)length
itform(s) _ LL . e.T rT—i i� r—r—i r
Platform(s)
ier(s)
ngth
-nber
i/ Riprap len h_
distance shore
x distan4offshore
cannel
sic s
ip
se/ tlift
illdozing X 7V
U �
_ I
a Length
not sure yes no
cum: n/a yes q� I
yes
\ttached: yes no
ig permit may be required by: �O
O C )Q V J <(— CL ❑ See note on back regarding River Basin rt
-ocal Planning jurisdiction) a I

;AMA EMERGENCY GENERAL PERMIT
if Oak Island
. Permit Office
iorized by the State of North Carolina
Coastal Area Management Act of 1974
�licant Name(- 0A-e[cx A/'4,0)cs-
,ress
ne# 24%t- 1.�7-Y-Si(
iorized Agent
of Project
ription of Activity:
of project:
or special conditions:
Permit #_ kI H / z — 14,0
Project Location Information
Street Address Zsq:�: kjV CIA k J)v-
Adj. Water Body 87( ,'If C t C_-
AEC: ❑ CS dOE Er HH ❑ IH
'r a Q- e A-V',)
V�v S

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: %3 W 15�e- h-A II r &-v- ( It+3
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
Nc
�rr'vN;Wr�)
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.
�1 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 http://www.nccoastalmana_gement.netlweb/cm/staff-listing 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=ation)
Signature
A�, LA 13r.
Print or Type Name
f a y �-
%Amilinn AArlrnoe
(Ripar'an Property Owner Information)
Signature
Print or Type Name
S- 3 z-)
Mnilinn Af*4rnoo

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
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
the re 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 90 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastaimana_gement.netlweb/cm/staff-listin_g 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.
(Pr petty f ner Information)
Signature
Print orj Type Name
(Riparian Propert O hformation)
-,,,---Signature
Print or Type Name
AA -;I;-- A,4,4-,,