67299D - Oak

CAMA / El DREDGE & FILL 4 11171 � � A B
EN ERAL PERMIT 7 -
Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern purp ant to I SA NCAC
/V A U'- O Rul attached.
it Name, JJ3�ii� �Prbject Location: County 1),
1 t�' i ✓A(—Sttrreet Address/ State Road/ Lot #(s)
Statee_ ZIP�`J
�qU ' j --Mail ' Subdivision
zed Agent 4L �1 l►�iG 4- 2 m nG ,� l City M' ZIP
❑ CW ❑ EW ❑ PTA_ ❑ ESL) ❑ PTS Phone # ( ) River Basin VNA
COEA ❑ HHF ❑ IH ❑ UBA ❑ N/A I /
Adj. Wtr. Body na
❑ PWS:
yes /(no' PNA yes no Closest Maj. Wtr. Body
,f Project/ Activity
1- i':..% vlr V'_ kA
a orm(s)
3ier(s)
�ngth
ember
id/ Riprap len
Je�
u/ Boatlift
r
3ulldozing X
lop
ie Length J
not sure yes
rium: n/a yes
yes
Attached: yes no
ing permit may be required by:
Local Planning jurisdiction) 4
(Scale:' }
NITA A" �R. Ki ME
!1 ❑ See note on back regarding River Basin r
{ /

NC Division of Coastal Mgt. t IMPaCt Computer Sheet
Applicant; Permit
Date: 1 I r�
i
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
(AppJ ed.for.
Disturbance total
includes any
anticipated
restoration or
tem impacts
FINAL Sq. Ft.
(Anticipated final
disturbance.
Exdudesany
restoration
andiortemp .
impact a1m�ount
TOTAL. Feet
(Applied for..
Disturbance .
total includes
any anticipated
restoration or
temp impacts.
. FINAL Feet
(Anticipa;#tnaI
disturbance.
Excludes any
. restoration and/or
temp impact
amount)
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 Q Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

CAMA EMERGENCY GENERAL PERMIT
INFORMATION
i of Oak Island- �� �J� Permit #
[A Permit Office
ithorized by the State o North Carolina
he Coastal Area Management Act of 1974
pplicant Name iM&'d7QA[od�
r
ddress i,►
ity Q " yr,,— o
lone # l" / o -' 52 Q - :�ZSx
ithorized Agent
pe of Project
scription of Activity:
>hl_C" 4'04AI A
ist of project:
ites or special conditions:
Project Location Information
Street Address0,0 / Lel, , 94
2 G Z
Adj. Water Body'
AEC: ❑ CS [�OE E;J�H ❑ IH

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: 9
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 2 10� 4,2,
in je&A�a/'Lmounty.
1 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:
Sig
Pri or Type Name
Title

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: �pL g 171,�k46L ,='
Address of Property: /j,
Lot or S reet , Stre t or Roa , City & Count
Agent's Name* -f �� Mailing Address:'w
Agent's phone #: �% ���/'� !j ^ ,�' f ���, �7 J&i�
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 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)
Signature
Print or Type Name
(Riparian-roeProerty Owner
•- ,, _
Mailing Address
Mailing Alddre7ss

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
ime of Property Owner Requesting Permit: L� +L
ailing Address: E. OaL Is 13,r4l
one Number: �A`7 8 -. ffjOZ4
pail Address: jo-aL-C.Aa^ 4. r%C--u-S
ertify that I have authorized T) 0(-)0y Le0n3('A ,
Agent / Contractor
act on my behalf, for the purpose of applying for and obtaining all CAMA permits
cessary for the following proposed development:
Vc,� h � t►� ry)(-. JL- n-, r <, 44-, 2C' * P Ic . I�
my property located at D411,11- O _ W S1Ye4 e(\l
t ,,),, County.
arthermore certify that 1 am authorized to grant, and do in fact grant permission to
✓ision of Coastal Management staff, the Local Permit Officer and their agents to enter
the aforementioned lands in connection with evaluating information related to this
rmit application.
)perty Owner Information:
-'-t � Al C.-P i",
Signatur
-Jv
t or Type Name
ojQ) 5 Sy taker i N�c ►r-�� r✓�
Title