54515D - Ollice

CAMA / DREDGE & FILL
23 E N E RAL PERMIT Previous permit #
New -Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
Drized`by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC '7
[:;Ales attached.
-it Name A) JLLI OL-L— f C-C Project Location: County &(,( lU5L'0 0C
l.�L li-N✓,� State _C ZIP_
t (r ) 2-78'7 323Fax # ( )
,ed Agent
CW EW PTA F-ift ❑ PTS
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
PWS: ❑FC:
yes /Aa) PNA yes / no Crit.Hab. yes / no
l
Street Address/ State Road/ Lot #(s)
rtY�
Subdivision
City G�`� ZIP
Phone # ( ) River Basin
Adj. Wtr. Body DA-VJ,S /' Y'
Closest Maj. Wtr. Body
length
■■■■■■■■■■■■■■■I
number M
■■■■■I=EENMEEE
M■■■■■■■ ■■
■■■■■■
avg distance offshore ■EM■■■ ■■■ nTA1i1max distanceoffshore- NMMMMMMMFW_
YJASK
mmommo�■mm�mmmv
channel
■M■■■ ■ ■ ■
:ubic yards_ ■■■■■■■■■■■■■■■■Muni
NO■■■ ■■■ ■■471
MME now ■R11 rail ll
Bulldozing
&
Z-r S
line Length
not sure
yes
ram'
ags: not sure
yes
no I `
orium: n/a
yes
no
s:
yes
no
r Attached:
yes
& L
ding permit may be required by: Vf�le �SL�r/� ❑ See note on back regarding River Basin
i f " 7 L1 l i r) ii I r, j*i

�o

rage
ADJACENT RIPARIAN PROPERTY OWNER STA'1'k:iNUNT
(FORA 11EP,,A1DORVVG' P11.LVGSB0'4T1<IFT1 O'4Tll()f;S1:)
I hereby ceftit'y that }own property adjacent to i —
uName of Property thvlrer}
property lucatedat._..''Lut Block, Road, etc.)
in
(Waterbody) ('Fo�vn andlor County)
He has described to ine, as shown be low, the ctrvelrapnient lie is proposing at that le�c€Iti.�f;; and, I hltv<.
na objections to his rm.posal. I understand that a pienmooring pilings 1' boatlift 1 boathouse must be seat
hack a minimum distance of lii'tcen feet (I y) frolit my area of riparian access finless waived by me.
(if you wish to waive the setback, you must initial the appropriate blank below.)
do not wish to waive
1 do wish to waive that setback requirement.
-------------------------------------------------------------
-- -
D SCR1P')t'IOiN ANDIOR DRAWING Ok' PROPOSED nEYf:i.()Pl4tir i+iT:
(To he filled in by individual proposing development)
(Information -for Property Owner/Applicant
Applying for permit)
ailing Address
City!Statel7il�
ti N 2
lClcpltOflc IVUt)1t�Cr
Signntnn to
if
(Riparian Property Owner Information)
D g/z
Print or "Type Name
7eleph�+ne I ufnbrr
taa�

Page I of I
ADJACENT RIPARIAN PROPERTY OWNER STA'I'EiVIEVT
(FOR A p1ER4100RING P11JV tGSBOATLIFTIBOATHOliSE)
1 hereby certify that I own property adjacent to W I s
(Naare of Property Owner)
property located at
Lot
on _��Zj C Q hot
(Waterbody)
etc.)
I own and/or C'ouilty)
lZm
He has desrr;buc'. to :na, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier(mooring pilings I boadiR / boathouse must be set
back a minimum distance of fifteen feet (15') front niu area of riparian access unless waived by me.
(If you wish to waive the setback, you must initial the appropriate blank below,)
iol I do not wish to waive
I do wish to waive that setback requirement.
----------------------------------------------------- ----- ---------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner/Applicant
Applying for permit)
I 2i 1�- "5 �. _--
Mailing Address
ct
City/Statelzip
'Telephone Number
1 o ivub
(Riparian Property Owner Information)
• Signature
Printor Type Name
-
Telephone Number.
16 ZU-/d.

Division of Coastal Mgt. Habitat Impact Computer Sheet
cant: 0 L i ce yell LL►aM
. 11/q)IC
j�L2rv� ►r �. 5y� ► S
ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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 final
disturbance.
Excludes any
restoration and/oi
temp impact
amount)
L M
Dredge ❑ Fill ❑ Both ❑ Other [�
1
Dredge ❑ Fill ❑ Both ❑ Other
T
Dredge ❑ Fill ❑ Both ❑ Other Z/
I ©
Q
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 ❑ Ot�[]
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge 0 Fill ❑ Both ❑ Other ❑

WILLIAM E. OLLICE 3383
MRS. WILLIAM E. OLLICE
P.O. BOX 397
OAK ISLAND, NC 28465
'p1 7
/f/rf/ :�/- //e
oll/c
66-112/531
1
6.evrlr
F..run
(AF15545DCQ-J
` ` BRANCH BANKING AND TRUST COMPANY
1-800-BANK B/BgLT BBT.co/mm/y�J 74�
: M
l:053 10 112 0:0005 21683 1669003383
H. l.m Clarke