Stovall Docking Facility (2)

0 z1 CTI Nn, - NC Division of Coastal Management 6255 ABC®
Cashier's Official Receipt
4
WO (OA''i '
1\ tftoiv 1 -f?Iv ' pie Date: r 720/l "Received From: $
Permit No.: - 1 (Mr/0 Check No.: V g
Applicant's Name: riAilikt,(--- - vQ- a County: 4../It
Project Address: 12)405-
/W5- r4. fJ, rlie-'"Q/- / 4/C..'
C�
Please retain receipt for your records as proof of payment for permit issued.
•
. Signature of Agent or Applicant. ••� y� Date:
r
. Signature of Field Represent.PlialaI Date: