54516D - Almirall

' CAMA / DREDGE & FILL
3hE W E RAL PERMIT Previous permit #
I ;ew Modification _Complete Reissue ❑Partial Reissue Date previous permit issued
,ized by the State of North Carolina, Department of Environment and Natural Resources —7
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1 C%
«« L;t ules attached.
t Name V fV)\ V � 1 _ Project Location: County LNl V-'V\) , c. k
Street Address/ State Road/ Lot #(s)
n State ZIP A- U V U,
( iQ} Jtx -,.Fg ax # (%t�_) j �j� Subdivision
ed Agent _ 1 ' City ZIP 101.
g � ��' t�l � � , tY
Cw Aew CU'TA [-ViS C] PTS Phone # ( ) River Basin 01?
❑ OEA ❑ HHF ❑ IH ❑ UBA ] N/A
Adj. Wtr. Body nat
❑ PWS: ❑ FC:
yes /� PNA �/ no Crit.Hab. yes / no Closest Maj. Wtr. Body
Project/ Activity
length
pier(s)
length
number
ead/ Riprap length ✓ .
avg distance offshore `V
-nax distance offshore
channel
:ubic yards_
amp
ouse/ Boatlift
Bulldozing
f
ine Length t
not sure yes
igs: not sure yes
:)rium: n/a yes
yes f
r Attached: yes
ling permit may be required by: 0` V, I!SL. NNq
bXYt4i--( Pe VAiT_ V\Ny L
r
(Scale:
❑ See note on back regarding River Basin
•---- -- A —t-r --f L-L it — _1 a ,-. . ,ti —A li.? . %.

2712010 10:22 Oak Island Medical Center (FAX)910 278 1415 P.0021002
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
vedy Eaves Perdue James H. Gregscn Dee Freeman
ivernor Director Secretary
AGENT AUTHORIZATION FORM
Date:
me of Property Owner Applying for Permit:
mer's Mailing Address:
Or
0a6C
WC-
lone Number f a)
Name of Authorized gent for this project:
Agent's Mailing Address:
C �-
Phone Number(gla) 06 --?-2g7
;ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
r and obtaining all LAMA Permits necessary
ato install or construct the following (activity):
keY)C"ir bGcf/Khe0-d
ny property located) at
0 e<k _-r-s k n eQ / /\/ G .Z eF4-G -�—
his certification is valid thru (date)
i o -'a -7 ` -Z 0 / /
Property Owner Signature
Date

7712010 10:21 Oak Island Medical Center (FAX)910 278 1415 P.0011002
Oak Island :? MEDICAL CENTER
affiliated with Novant Medical Group
8715 E. Oak Island Drive I oak Island, North Carolina 4846s
Phone [phone] Fax: 910-27$-1415
www.0a61andMed.0r13
FAX C0VER-S H EE­-_T
/0-27—/o
NUMBER OF PAGES:
(including this cover page~
)ANY:
r-e- C1174-1
r r Zctt/ 6 Fo r—, `
ID /I
- IF THIS TRANSMISSION IS INCOMPLETE PLEASE CALL SENDING PARTY_
ial Notice: The documents contained in this telecopy transmission include privileged, confidential information
to the sender. The information is intended only for the use of the individual or entity named above. if you are
ended recipien4 you are hereby notified that any disclosure, cogvinR, diRIA111inn rho r.l,r..,, ,.t . -

!312010 11:07 Carter Funeral Home ff AX)9108952939 P.001
ICT-13-2012 10:e5 From: Toi919253913Q, P,6�3
t..d ^ buivw I
I
ADJACENT RTPARI .N PROPERTY OWNER STATEMENT
I hereby certify that I own PTO -y adj cent to 2��k lmlvyi t
(Name of Property nor)
property located at 9 a '/S- 7 � �� erk6 D106 Lla 1510-y-J
�'Lot, mock, Rood, otc.)
C-eL4P✓
on iJ in Ci i N.C.
(Watorbody) 1 Crown Aadior County)
i
Applien.nt'sphonefit: 0-,�(8 ilingAddress: e7� -- 0"K.is041�
a/o vZ6q // 0 , �K.�� °� ivG 2
He has desoribed to me, us shown b4: ow, t4 dcvelopmont he Is proposing nt that location, and,
havo no objoctions to his proposal.
............................................ ........«}................ .......... --
l?riSC'RrrTION AYD/0.MDRAWVING Or PROPOSED Dt ,L0PMENx;
(To bit filled In b,I propirrry owner proposing devolopnrcrit)
� ,a;,r bat i6t ad o'5 Ate�'p c l
......... do ... .w......w.ww..w.....w....l,...... • . . M......................M......N.. U.•\wr.�.. «..w.
(Information for Property Ownci;,;ApplyTng (Riparian Property Owncr Information)
for permit)
8'1I5 _tertc>,s�w�0A
Mailing Address
j
C)C�k �S'64-4) fJ L
� It,11 o/,� _Sc'w-�
signature
Maw y
�� Print or Type Name
— n -, -- /' /' / n

r-13-2010 10:05 From: To:9102539138 P.6/8
ADJACENT .RIPART..N PROPERTY 0`vS l ER STATEMENT
I hereby certify that I own prop -t adj�cen, to I fZ—
VlR',
(Name of Property Ow er)
t - — A _ —,
property located at
,,lot, Dlkc, Road, etc,) /'
on l Q��✓�� in.%Ci nS 1,N.C.
(Waterbody) (1ow
n
nd/or County)
i
AppliennC's phone ki;,: g
IVU. ilin Address;____
N�
�j/o--,�64—//°/� a285�
He has described to me, as shown b4 ow, thdeve"opment he is proposing Lit that location, and, [
have no objections to his proposal,
.............. ............................. . ..................................
D.CSCRII'T.ION AND/On DRAWING Or PROPOSED D1:Y(:LOPMLrNT,
(To be filled In b propzi y owner prepnsing dsvelnpmertt)
II
n
e��d,
(Information for Property Ownei
for Permit)
..................................................
.,..........................................
Apply1ng (Riparian Property Owner'loformation)
e� 15 IE7 . 0c.k lskoca
Mailing Address
i
(�,� Isitxhc� N C a8�(�%
City/State/Zip qlu Zbut— j 10 j�
�Signature
La r z—
Print or Type Name
- i _ /

Division of Coastal Mgt. Habitat Impact Computer Sheet
ificant:• i/-4(,M14tqt� 610#:SqS)
to
e: j 01Zq/l p
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
nd in your Habitat code sheet.
)itat 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.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
A
�uv
Dredge ❑ Fill [Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
" oo
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 ❑

MARILYN AIN OR PETER D ALMIRALL 8302
8716 E OAK ISLAND DR 66-112/531
OAK ISLAND, NC 28465-8367 oc / . _ -T
Mal
Ttx�
BRANCH BANKING AND TRUST COMPANY
t-M-BANK SOT BBT.com c c w e e i s
1:0 5 3 L0 1 L 2 11:000 5 2 16823909116483 2