67105D - Martin

CAMA / ElDREDGE & FILL Vr,
A B
IE NERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources -'
oastal Resources Commission in an area of `environmental concern pursuant to I SA NCAC a hed.
Name V ti-1�S U Y �li� �� 1 Project Location: County
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�' yi Street Address/ State Road/ Lot # (s)
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State ZIP_
Mail _ Subdivision ZIP
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ad Agent CIS'
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
)EA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ves / 40 —)
Project/ Activity
ck) length_
atform(s) _
Platform(s)
;ngth
amber
id/ Riprap le gth_
g distance�ffshore_
ax dista4e offshore
hannel .'
ibic ards
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se/ Boatlift
Bulldozing c 1
ne Length
not sure yes —f
)rium: n/a yes
yeso —
r Attached: yes
n
ding permit may be required by:
a 1 ^—1 Plannina Jurisdiction)
Phone # O / River Basin
Adj. Wtr. Body I ^( n r
,U
Closest Maj. Wtr. Body,
(Scale:
1�� h ��� t ❑ See note on back regarding River Basin

AMA EMERGENCY GENERAL PERMIT
f Oak Island
Permit Office
orized by the State of North Carolina
Coastal Area Management Act of 1974
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dress 7 I.3 Z rb r►g-r k J1
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%orized Agent,
e of Project
�ription of Activity:
of project:
�s or special conditions:
Permit # i- j H I I `(,-j
Project Location Information
St et Address % 3J41 -1�Y'
Adj. Water Body
AEC: ❑ CS �OE O""HH ❑ IH

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Iame of Property Owner:
ddress of Property
gent's Name #:
jent's phone #:
2-3q,r V - Rex, -A D C, Oak, T� I CIA
(Lot or Street #, Street or Road, City & County)
Mailing Address:
iereby certify that I own property adjacent to the above referenced property. The individual
iplying for this permit has described to me as shown on the attached drawing the development
ay '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.
P P J P P
rou have objections to what is being proposed, you must notify the Division of Coastal Management
CM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is
ailable at httb://www.nccoastalmanagement.net/web/cm/staff-listing or by calling 9-888-4RCOAST.
response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
iderstand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
set back a minimum dis4pce of 15' from my area of riparian access unless waived by me. (If
i wish to waive the setback;,you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement
I do not wish to waive the %' setback requirement.
K(pari an
�iert caner Infor ation)
iatur
` or Type me
ng A1dressfl
( Owner Information)
Signature
Oe, C b /' 7,,yj
Print or Type Name
S12 -z Co
Mailino Address

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