OI_16-40_Vachon

Oak Island 0116-40
Local Government Permit Number
CAMA
MINOR DEVELOPMENT -�
PERMIT
as authorized by the State of North Carolina, Department of Environmental,
Quality and the Coastal Resources Commission for development
in an area of environment concern pursuant to Section 113A-118 of the
General Statutes, "Coastal Area Management"
Issued to Kerry Vachon, authorizing development in the Ocean Hazard (AEC) at 6705 W. Beach Dr., in Oak Island, as
requested in the permittee's application, dated 5/18/2016. This permit, issued on 6/10/2016, is subject to compliance
with the application and site drawing (where consistent with the permit), all applicable regulations and special conditions
and notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or
may cause the permit to be null and void.
This permit authorizes: the placement of fill 50' x 60' between the house and new berm with beach quality sand.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 5/18/2016 and missing information on 5125/2016.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for
compliance. Any maintenance work or project modification not covered under
this permit, require further written permit approval. All work must cease when this
permit expires an
DECEMBER 31, 2019
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal
Management.
Donna F. Coleman
CAMA LOCAL PERMIT OFFICIA�--, D
4601 E. Oak Island Dr, a-1.ON, NC
Oak Island, NC 28465
Auc,os2016
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Vachon
Minor Permit # 0116.40
Date: 611012016
Page 2
(5) The pennittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(6) Sand used to strengthen dunes must be brought in from an outside source and must be of the same nature as
the sand in the area, which it is to be placed. No sand is to be removed from the lot.
(7) In order to minimize adverse impacts to nesting sea turtles, no work shall occur within the period of May 1 through
November 15 of any year, without prior approval of the Division of Coastal Management, in coordination with the
North Carolina Wildlife Resources Commission and US Fish and Wildlife Service.
(8)Dune disturbances will be allowed only to the extent necessary for development and if the dune's protective value is
not weakened or reduced. Disturbed dune areas will be immediately stabilized.
(9)AII unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetatatively stabilized (planted and
mulched) within 14 days of construction completion.
(10)Any structure authorized by this permit shall be relocated or dismantled when it becomes imminently threatened by
changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time
when it becomes imminently threatened and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renourishment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or
dismantled at that time. This condition shall not affect the permit holder's right to seek authorization of temporary
protective measures allowed under CRC rules.
(11) The activity must not exceed the lateral bounds of the permittee's property unless he has permission from
the adjoining landowners.
SIGNATURE: DATE:
PERMITTEE
DCM WILMINGTON, NC
Aus 022016

A tioop signature verIDcation: ww doticmp.con'J,nyNei M,c uo,Vot..1558VOb3-4)Q)l
ABC HAZARD NOTICE
Project Is In An: '1 Ocean Erodible Area —High Hazard Flood Area —Inlet Hazard Area
Property
Property Address: (A ` o -s w . 6e c,.0 k
Date Lot Was Platted:
This notice is intended to make you, the applicant, aware of the
special risks and conditions associated with development in this
area, which is subject to natural hazards such as storms, erosion
and currents. The rules of the Coastal Resources Commission
require that you receive anAEC Hazard Notice and acknowledge
that notice in writing before a permit for development can be
issued.
The Commission's rules on building standards, oceanfront
setbacks and dune alterations are designed to minimize, but not
eliminate, property loss from hazards. By granting permits, the
Coastal Resources Commission does not guarantee the safety of
the development and assumes no liability for future damage to
the development. Permits issued in the Ocean Hazard Area of
Environmental Concern include the condition that structures be
relocated or dismantled ifthey become imminently threatened by
changes in shoreline configuration. The structure(s) must be
relocated or dismantled within two (2) years of becoming
imminently threatened, and in any case upon its collapse or
subsidence.
The best available information, as accepted by the Coastal
Resources Commission, indicates that the anmral long-term
average ocean erosion rate for the area where your property is
located is a feet per year.
The rate was established by careful analysis ofaerial photographs
of the coastline taken over the past 50 years.
Studies also indicate that the shoreline could move as much as
a ,Sfeet landward in a major storm.
The flood waters in a major storm are predicted to be about
1 feet deep in this area.
Preferred oceanfront protection measures are beach nourishment
and relocation of threatened structures. Hard erosion control
structures such as bulkheads, seawalls, revetments, groins, jetties
and breakwaters are prohibited. Temporary sand bags may be
authorized under certain conditions.
The applicant must acknowledge this informationand requirements
by signing this notice in the space below. Without the proper
signature, the application will not be complete.
Arinficant
/ i nat re Date
e>Ura / 111C�id/v 0=517.nrea
CEO5XE9K5 QSEpi
CEOQ%EOKGOSVNMWS
SPECIAL NOTE: This hazard notice is required for development
in areas subject to sudden and massive storms and erosion. Permits
issued for development in this area expire on December 31 ofthe
third year following the year in which the permit was issued.
Shortly before work begins on the project site, the Local Permit
Officer must be contacted to determine the vegetation line and
setback distance at yoursite. If the property has seen little change
since the time ofpermit issuance, and the proposed development
can still meet the setback requirement, the LPO wilt inform you
that you may begin work, Substantial progress on the project
must be made within 60 days of this setback determination, or
the setback must be remeasured. Also, the occurrence of a major
shoreline change as the result ofa storm within the 60-day period
will necessitate remeasurement of the setback. It is important
thatyou check with the LPO before the permit expires for official
approval to continue the work after the permit has expired.
Generally, if foundation pilings have been placed and substantial
progress is continuing, permit renewal can be authorized. It is
unlawful to continue work after permit
For more informatlon, contact
Ebt_-nJA_ F_ Onlcm
Local Permit Officer
4(D0I E, OaL a:S6rvd �D2
Address
nak `�siar,d,�r ZSy(�5
Locality
(C110) aot-- eo 49
Phone Number
cicolerviafn@ ci.oak-islax� • nc.us
RECEIVED
DCM WILMINGTON, NC
M4 0 2 2016
Revised Mf

PLAT OF SURVEY FOR
ANGELA NOURSE
6705 WEST BEACH DRIVE
LOT 3, BLOCK 139, KINGS LYNN
SMITHVILLE TOWNSHIP, BRLNSMCK COLNFY
OAK ISLAND, NORTH CAROLINA
0' 30, 60' 90'
NOIEi'
THE PROPERTY SHOVN HEREON IS LOCATED
IN A ROOD HAZARD ZONE •VE•. BASE ELEVATION
DETERMINED VARIES. FEE, F.I.R.M. COMMUNITY
NUMBER 370523. PANEL 2036. SUFFIX "C
DATED 6/2/06.
THIS PROPERTY IS LOCATED N OAK ISLAND
ZONE R-7.
SETBACKS FRONT 15, REM 2T, SLOES V.
THE STATIC VEGETATION LINE SHONN HEREON
WAS FLACGEO BY CAYA AND FLAGS LOCATED
ON AWUARY 29, 2016,
IMPERVIOUS MER CALCUUnONS
TOTAL AREA WIMN LOT - 750 .0 SOFT.
USABLE AREA (300t) - 2250.0 50.M
HWSE - 1107.8 SOFT.
GRAM. DOW - 2739 SO.".
TOTAL IMPERVIOUS - 1381.8 SOFT.
WEST BEACH DRIVE
60' R/W
a�
EDGE OF PAVEMENT
S 80'OG•DO• E 120.13'
sow
�{.• .6RI4EI••'I
AM
a
DID
-
MRS
'VE• 1T 1252 S
T
7.93 TC9V'B 17.&V 1
PLATFORM
WOOD _- f li
'•STATIC LINE
IDT
AS F(YJ%D
STAKED /29/16
TOP, W SLOPE-/ .-' 7.99 8.3 '
•-_
•VE' IV
- - _ -
BOTTOM OF &OP��
`^ •'�• 20'
Y
LOT A _
'" $ LOT 2
�7
R $ 7500.0 Sp F.
$
0.2 AttN
_•
L%CEPT AS WFC H;A y SATED 9 WCAA
u 'COS RAT, M 9ry1EY DOES NOT RIRRW'
TO RULLLI N" OF T16 FW1M,R,G NHL` SAY
BE APLKaM£ IC THE SUNEET REAL ESTATE
£ASFVENS OTHER 1HAN POSSB_E EASENLNTS
1.7 MERE Vb F AT 11L I.E PF HAVING
OF ,PS RY1Kv: BLMD'NG SEIBACH L:VFS:
RESR ITYE CONYIAVI$ SVR TQPON KWSCT-
KA1 2CMHG OR GIKR LNA USE REGA ABOPS
A,I ANY OTHER EA IS THAT AN ACCJMTE ASD
CUPRENT TTLE SEARCH YAY LISGOSE.
STATE DF NORM CMDUNA
ERUNSNKK C01:1:TY
RDSERI S. UU RY. A CERTFY
1HIT 1. YAO WAS LPPHV {.'WIER Y1
SHPCRNSON TROY AN MTuAL FELD
1.11 MADE UNMR YT SUPERYADN:
TJAT TIE RAT* R PIE09W AS
GLCILAIIO BY LdUUTFR 15 IQ." +:
-HAT :HE BWEWMiES NOT SURVEYED
ARE SIOTVr AS WWN ONES PLOND
ERW MDRIVAea FOUND W BOR15
wtHEss Ery wx0 AND, SEA;. lay T2
19T1 DAY 6 aMUARY ✓ A . 2B
y�°ZHS�CA,
'Ob}
S=O�^�C551O� yy. •e
X R
_ SEAT H
iA L-35T. i
o 1}}-
fNYryO SUMT'J'pA ayPi
�7 ^*roHA' a
a6 HC P
HRHMOE,Aa
N
ATLANTIC OCEM
DATE CURVETED, JANUARY 20. 27,6
6Y PF/0
BY, CR}NREOY
MaHt,
ER a EIn5TN0 PER RR (w-D
NIP , NEW'RW — 41
E. - EYID%NG ... FO:NU
NFU Kw PERM W
166t . 'EMVCRART 11D1CH UA"
ES - E.ECIWC ROE
SCO = VEAEP C_EA?rj
YV - WATER uI-El
THE LIICRI:ONS CF J DERGItMWD UT.UT.
A5 9.0. HEREON ME BASED M ABON
(AdN: SxU ILRES SO RR6mE0 QRS.
PROMDED M: SURVEYOR. tMATICNS
UNEERWHEREC
KAMVIIEIT£5(S1MICt EI Y
VARY F L L RED "S 4gMN
YET BE ENCOUNTERED. RE EYCAYAt1I,
S RE SACF. LMA i,E PROin U UI ll
SUR1£Y iU L(ICaTE BURYO UPUI£;
STRUCTURES.
SCALE: I NCH =30 FEET
JCB NUMBER: 15-0542
i1:.ED BOOK: R&1-2015-10
MCHENRY SURVEYING
PROFESSIONAL LAND SURVEYOR
P.O. BOX431.85%E. OAK iSLANO DR
OAK ISLAND, NC. 2BUS
TEL' 910.27&9974
FAX:[phone]
F • 0471

ialoop Mgnatvle v,I lcatlon: www.dn[Ir up.mnJnry/v±ii8callon/t)1-16588)083-3-2pn
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: I t/✓l A rark,,,
Mailing address: e)r cL,1 j Q cy SCP ✓1 f
Phone Number:
Fka/-k 8e,-s
3 - (2�a1 - Ins A
I certify that I have authorized � t l Y 1 ST rl C- CV-011 t C
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of Sa n re kn C P P-re rN
at my property located at (_Q 1y V W & 0-C
P
in�rr-Xtn,CLk)',CIC County.
This certification is valid through ID 3 � - 10 \ U
Date
(Property Owner Information)
W T3R6EWPL-1" tlotloop♦e
0925/16 955AMH�PBY1 EOi
1RA
Signature
"I(' Y" f
font or Type Name
D k-LAIC' ✓
Title
-as-2c�tU
Date
31q-
Phone Number R EC; E i V E D
VCtC�dC) Q5. C owe DCM WILWNGTON NC
Email Address JUN 0 0 206

May 23, 2016
Robert & Michelle Bomholt
880 Evergreen Lane
Jasper, IN 47546
Dear Adjacent Property Owner,
This letter is to inform you that I, Kerry Vachon, have applied for a CAMA minor permit on the property
at 6705 W Beach, on Oak Island. As required by CAMA regulations, I have enclosed a copy of my permit
application and project drawings as notification of my proposed project. No action is required from you
or you may sign and return the enclosed no objection form. If you have any questions or comments
about my proposed project, please contact Christine Cronick at 910-367-2508, or by mail at the address
listed below. If you wish to file written comments or objections with the Oak Island CAMA Minor Permit
Program, you may submit them to:
Sincerely,
Kerry Vachon
Donna Coleman
Local Permit Officer for Town of Oak Island
4601 E. Oak Island Drive
Oak Island, NC 28465
RECEI\/ED
[)CM WILMINGTON' NC
JUN 0 2016
Domesticall Onl)
For. deliveryInformati
Jill ♦4 L .. '....
a
r9
Certified Fee
1:3
17
Retum Receipt Fee
(Endorsement Required)
0
Restricted DeMery Fee
p
(Endorsement Required)
to
D'
Total Postage & Fees
0
�(p RECEIVED
3W)(D
Pio=j 6
Ln Sent To i�y, \
p 3ro"eei8iip'i.No;- -/ p-l-`�'� -- ual
r1 orPoBox No_
r_.[�_v _._. �. 1�:Qe--- - --- �%-
City, Stae, 2/P+4-
r

May 23, 2016
William Dooley
835 South Lumina
Wrightsville Beach, NC 28480
Dear Adjacent Property Owner
This letter is to inform you that I, Kerry Vachon, have applied for a CAMA minor permit on.the property
at 6705 W Beach, on Oak Island. As required by CAMA regulations, I have enclosed a copy of my permit
application and project drawings as notification of my proposed project. No action is required from you
or you may sign and return the enclosed no objection form. If you have any questions or comments
about my proposed project, please contact Christine Cronick at 910-367-2508, or by mail at the address
listed below. If you wish to file written comments or objections with the Oak Island CAMA Minor Permit
Program, you may submit them to:
Donna Coleman
Local Permit Officer for Town of Oak Island
4601 E. Oak Island Drive
Oak Island, NC 28465
Sincerely,
AWAQ RECEIVED
5)2a(lic�
0
Kerry Vachon
OilEN� 7°480-
r7IPomage&Fees
$3. 1 0422
postage — 06
er $O.GO .
Certified FeeF
'PdsMark.
Oceipt Fee 1 $Q tjQ Here
ORequlred)
llYery Fee .. -
Requl$reoa)
RECEIVED Ere a E3s 05/24/2016
DCM WILMINGTON, NC Ln, Sen,Te
III^I `? 2018 0 orreet&rxNo. . $ 3 .S, 1
f• or PO BoNo. L_Yj�i-1-�`r?----------------

Donna Coleman
From:
Donna Coleman
Sent:
Friday, May 20, 2016 8:55 AM
To:
'Christine Cronick'
Cc:
'[e-mail]'
Subject:
CAMA Minor Permit - Vachon
Attachments:
Agt Auth 2015.doc; AEC Hazard 17.pdf, ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS.doc; CAMA Minor Application OI 16-40.pdf
Dear Kerry
We originally accepted your CAMA Minor application under the impression that it was complete. On subsequent review,
I have discovered that additional information is needed to complete the review process. Accordingly, I am requesting that you submit
the following additional information to this office:
✓I. A signed Authorized Agent form by the buyer.
2. Signed AEC Hazard Notice by the buyer.
5(1,{1l4 X. Copy of the letter sent to the adjacent riparian owners, (I have placed their names and addresses on the application) and
a copy of the certified return receipts.
In accordance with the Department of Environment and Natural Resources regulations, we note that a certain time has passed while
the application has remained in our office. Upon resubmission of a complete application, alocal decision will be made in 20 days.
Please contact me at [phone] if you have any questions.
Respectfully yours,
Donna Coleman, LPO
Donna F. Coleman, CFM'
LAMA-LPO / Building Inspector
Town of Oak Island
[phone]
_(910)278-1811fax
RECEIVED
DCM NNILMINGTON, NC
t JUN 0 2 2016

Oak Island
Local Government
j f 0116-20
Number
Permit Number
CAMA
MINOR DEVELOPMENT
PEWIT°; ..
as authorized by the State of North Carolina, Department of Environmental,
Quality and the Coastal Resources Commission for development
In an area of environment content pursuant to Section 113A-118 of the
General Statutes, -Coastal Area Management"
Issued to Kathleen Hagerman, authorizing development in the Ocean Hazard (AEC) at 6705 W. Beach Dr., in Oak
Island, as requested in the permittee's application, dated 2126/2016. This permit, issued on 3/23/2016, is subject to
compliance with the application and site drawing (where consistent with the permit), all applicable regulations and
special conditions and notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment
or civil action, or may cause the permit to be null and void.
This permit authodzes: the placement of beach compatible sand on the Oceanside of the home at the escarpment, 5' in height for
60'toward the ocean only.
(1) All proposed development and associated construction must be done in accordance with the permitted walk plat
dra vings(s) dated received on 212612016,
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permillee or other qualified persons
within twenty (20) days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for
compliance. Any maintenance work or project modifca(lon not covered under
this permit, require further written permit approval. Allwork must cease when this
permit expires on:
DECEMBER 31, 2019
In issuing this permit it is agreed that this project Is consistent with the local Land
Use Plan and all applicable ordinances This permit may not be transferred to
another party without the written approval of the Division of Coastal
Management.
Ff-_(:tivLU
n(" ^kl NC
JUiu
Donna F. Coleman
CAMA LOCAL PERMIT OFFICIAL
4601 E. Oak Island Dr.
Oak Island, NC 28465
pit' S .I'+.'i; ,; e ,t. FDA Por &ihlrrrrl
t rPERMiTTEE WlTvy'AM
(Signature required if conditions above apply to permih'
R EC"-'
DCM WILMINUl"UN, NG
JUN 0 2 201

Name: Hagerman
Minor Permit # 0116-
Date: 3/2312016
Page 2
(5) In order to minimize adverse impacts to nesting sea turtles, no work shall oxur within the period of May 1 through
November 15 of any year, without prior approval of the Division of Coastal Management, in coordination with the
North Carolina Wildlife Resources Commission and US Fish and Wildlife Service.
(6) Earth moving equipment must be brought onto the beach at an authorized location, not across existing dunes/berm
or unau0rorized private property.
(7) The activity must not exceed the lateral bounds of the pennittee's property unless he has permission from the
adjoining landowners.
(8) Sand used shall be of the same general characteristics as the sand In the area in which the material is to be placed.
In order to ensure compliance with this requirement, the permittee shall coordinate the location of the sand borrow
source with a representative of the Division of Coastal Management prior to the initiation of any sand placement.
(9) The contractor must submit analysis for sediment compatibility prior to any land disturbing activity.
(10)AII unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetatatively stabilized (planted and
mulched) within 14 days of construction completion.
(11)This permit does not authorize any fill seaward of the previous dune restoration and newly planted sea oats.
t, P.0 A.fDr 11a�4,lreni� t�mcxr
510NATURE:1�( v DATE: 3fr' 4 2UJtc
PERM TTEE ,
t—t- ECOVED
DCMI WILMINGTON, NC
JUN 0 u^016

Locatity_(,�ak ISIOAA Permit Numberol It0-go
Ocean Hazard Estuarine Shoreline_ ORW Shoreline _ Public Trust Shoreline_ Other J r! t
(For official use only)
LAND OWNER
Address i •J Rr e a i I ., 0-(e.3C e n k
city Fl a n d e rs state N's zipf7 n, Phone 9'13 - ci -) 3
Email 0 ( -�QC {' 0n P 1) k �,� S. COrt�.
AUTHORIZED AGENT
Name C k ✓I SS-6 n t 1 r _✓(il1 , C1C
'Y Address �ia.C� of la-b ec,
City �r�l_^_ +� State KL Zip7a Phone CC-)
Email (�Y1r1 S'{'1ne Ck✓S-�neC VCv,), CA. C 4,1)"'
OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
an owner or record title, Title is vested
page in the
County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
see Deed Book
,Aif other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OFADJACENT PROPERTY OWNERS: w
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
LOCATION OF PROJECT:. (Address, street name and/or directions to site. If not oceanfront, what is the name of the (1)
adjacent waterbody.) (-P (� Qe n-k (2)
!� (3)
DESCRIPTION OF PROJECT. (List all proposed construction and land disturbance.) S19 rJ O K<PCdk emt J (q)
SIZE OF LOT/PARCEL: %5Z� square feet acres
PROPOSED USE: Residential 121 (Single-family EY Multi -family ❑ ) CommerciaUtndustrial ❑ Other ❑
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: 010k- square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECa: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: _ square feet (includes the area of the mof/drip line of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
ED
STATE STORMWATER MANAGEMENT PERMIT. Is the project located in an area subject to a State Stormwata \%
Management Permit issued by the NC Division of Water Quality? ` ivi r-J i'_iv i vGTON, NC
YES NO ✓ If yes, list the total built upon area/impervious surface allowed for your lot or parcel: sgt)W" 2 2016
(Name)
(Address)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I 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
This the _ )S� day of�AQ._, 20 (.r
Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a checkfor $100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in anypermit which may be issued Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.

bLK I AKLA
4-5' AVERAGE HEIGHT THROUGHOUT BERM
6706 NEST BEACH DR
OAK ISLAND NC
44" /in inriv -"a- -

RECEIVED
DCM MMINGTON, NC
JUN 0 2 2016