67921D - Herring

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: V
Date: .
Permit ##: (f' c4a( (�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp imjjpacts)
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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge [I Fill [I Both ❑ -0therx�,
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 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

.AMA EMERGENCY GENERAL PERMIT
of Oak Island
A Permit Office
thorized by the State of North Carolina
e Coastal Area Management Act of 1974
plicant Name ki'n y6y'l n4Sr
dress \ 0'7 Surti(n.+ (i
y G; Jxv, . /N c- a e3 a$
)ne# 911p--99Q-,-1-738
thorized Agent
ie of Project
cription of Acti ty:
V\er�:,
i s 1 c
P1 n•ae
t of project:
es or special conditions:
Permit #
Project Location Information
Street Address as i w p 6 0 e-
-T.,e N c -wq-( s
Adj. Water Body oc-c.ah
AEC: ❑ CS ❑ OE ❑ HH ❑ IH
j-4 a -al 75 ff w'de
qy\
L-ow ��� r
_ SITE DRAWING
G
uj SAa u
�vw �A�L mar{
-to Scco�d�ur� a+..
Pti r.ao� �.tr•t5

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: `1DjM
CA'A,,1
Phone Number: � lD — 3n
Email Address: Q MRi . c-DM
I certify that I have authorized �Aerr�y,-!5 Sr
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMAnpermits
necessary for the following proposed development: k0c o-
[1
at my property located at ep-� J�r'oe, 0, S(J /(X;- ZN6 S
in 114 w CCL County.
I 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.
Property Owner Information:
Sign
C'- 1 �r
Print or Type Ibme
Title

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
-;?41 W
r
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Z TN\ �CrrNc, I Mailing Address: ODD 0
Agent's phone #: qk0 6tq'0 9,7SI C�kv." V\ I A X, ag 3a 8
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 90 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastalmanagement.netlweb/cm/staff-listing or by calling 9-888-4RCOAST.
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
R M.
'rint or Type Name
\-D-1 S L-*,W:A-
(Ripar'an rope#y OWWr rmation)
Signatup
/r
G� .
Print or Irype Name ll
S/SOO k r �ZA9
dailinq Address
Mailina Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 1 TV\
7:yr
jj ✓ T � (�
Address of Property: Q ^Sri ��— OAL •+-s�a�d( IVY'` 2-1 i (J
(Lot or Street #, Street or Road, City & County)
Agent's Name #: 'Z'M� ,,1r
Agent's phone #:
,�\Vo omfo a-738
Mailing Address:©i ��`"""^� } R� Inc
GVv--NX.- aS3a8
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 http://www.nccoastaimanagement.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.
(Property Owner Information)
(
,, r
w-.
Signature
Print or Type Name J
(�
� i I p � SilMv►�� �\�L'jG 1�
(Riparian Property Owner Information)
Signature
i
w�llliflen f'�IS3�� �la1i�
Print or Type Name
'-A :��s n )A r 44nw PI
AA-;i;-- A.J.J.-. --