69155D - Livingston

Nq Division of Coastal Mgt. Habitat Impact Comi
Applicant: �"V-j
Date: y Ja 4�� ]j-'zt—
Describe belo the H TA disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
(Ai
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex
anticipated
restoration
any anticipated
re:
restoration or
and/or temp
restoration or
ter
temp impacts)
impact amount
ternimpacts)
an
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 ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:,�..ar� L%NkyS'`
Mailing Address: L// �/) fa:jC l/{�
Phone Number: 9/D — %a —
Email Address:
I certify that I have authorized JCCr
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits n
necessary for the following proposed development: V�vc. S��
�ty..-. S • d4 r �c
at my property located at SU7 w /Ak T x nJP ,
in County.
1 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:
Signatur
Print or Type Name
�c✓�2
Title

7016 2140 0000 0834 8327

CAMA MINOR PERMIT PROGRAM
❑ MODIFICATION ❑ EXEMPTION ❑ MAINTENANCE AND REPAIR
Town of Oak Island
CAMA Minor Permit Office
ks authorized by the State of North Carolina
per the Coastal Area Management Act of 1974
Applicant Name
Address '-// 45— 1:ayd vi ('t.
City L ,, , (UC. a$ �S
Phone #
Authorized AgentJeFF A/C—O, e16 3 a
Type of Project
Description of Activity:
_SW �.0 U n CiCt�Afl ,f i � d
Notes or special
conditions: Cost of project.
Permit #
Date previous
permit issued_
Project Location Information
Street Address_ _ L d) w Qc c,h _
0 �f .k1 4n ty
Adj. Water Body / -A*,+k C c-rur.
AEC: ❑ CS 2-0E ❑ HH ❑ IH