67917D - Lilley

NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant:,,'
Date:
I
Permit ##: (,Qi�i I ---H
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 impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Exdudes any
restoration
andfor 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 [IFill [IBoth ❑ OtherL"
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 ❑

LAMA EMERGENCY GENERAL PERMIT
INFORMATION
n of Oak Island
ZA Permit Office
uthorized by the State of North Carolina
he Coastal Area Management Act of 1974
pplicant Name L-k\
ddress qcscp 4-
ity
hone# g10� —a91 - 5\—Ia
uthorized Aeent (IY\N- ^C If
(pe of Project
xcription of Activity:
��'r1CJ r'o
)st of project:
)tes or special conditions:
Permit #
Project Location Information
Street Address o`Z�3 �30-�• LAG
Adj. Water Body Ar-� koef. -- C7CLC�
AEC: ❑ CS ❑ OE ❑ HH ❑ III
::>t D -1,3 L_,, . lb�0-- �>Y . — o' w�"Aj,
stt �'4 S
SUE DRAWING
,Q---

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: oy9It Ile- 1Z
Mailing Address: _ S 00 ki r kAp�rrj (�
Wake F—cr�es� �C
Phone Number: 9 1 q- ZCt 1— S 1% 0
Email Address: c! 1;((ej4 2pj (i A) AR- Corn
r
I certify that I have authorized R ty\ Vyrr x,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: N s L h e f4 S A IOd FvoM
�ocd f (Ve%/`Ayk fa A-PAt r lfieo1",,-5-1 /'rIt17Ar (,a Se 0,ndr1mN
at my property located at Z 2 3 We4 Be-tld & o41 /sA-,VW Ai c Z w.5,
in Brum5 w i V 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:
' $ignaturh
O //9'r & 1"'ller
Print or Type Name
0
Title

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
L(I(et
Address of Property: ZZ3 Wf-4 13Vpch pr /0hk TS1AA)I A) Z�q6S
(Lot or Street #, Street or Road, City & County) + c�
Agent's Name #: � M Mailing Address: �� l Su" � �r W
Agent's phone #: cAW0 910 a73q C.\:� �4UL aS3,ps
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.
P 07ty 07ner Ipfo ation)
5rgna`ure
L,�
Tint or T pe Name
2ailina Address
(Riparian Property Owner Information)
Signature V
Print or Type Name
VQ-1 �JIe.
Mailina Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: Z Z 3 L)eG � L?C''qCn.- 04,1-, Nc 2- `6 Y65
(Lot or Street #, Street or Road, City & County)
Agent's Name#:
Agent's phone #: c-\\,o c�GU
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.
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!; tt�:,;'�^ :sect : ,:re:: �:s¢. roJ.:et:,'L::��staf ` 4: : y or by calling 1-888-4RCOA ST.
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.
(Pro Own Inf n)
Signal e
Print or Type Name /
ySOo kr/-b--7 m r
(Riparian Property Owner Information)
Sign re
,Tam & Gh `t a r'e << 0�'
Print or Type Name
►�yc� C_ ha�fy-���s ��I�� 31��