74241D - Green

)�CAMA / XDREDGE & FILL NO. 74241 A B C
GENERAL PERMIT Previous permit #
)New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 11 00
❑ Rules attached.
Applicant Name KiGNTJN GR+r-P-J
Address 107 ClxroIZD Cy -wily- Rv
City C "Y State NC ZIP 275)q
Project Location: County -0 gAA Ns w t c- K
Street Address/ State Road/ Lot #(s) 4�
nGIEAU1 &-VD W V-ST
Phone # (919) 637 - Odd a E-Mail ke—� �A r ce^ &°�AA. c,*m Subdivision
Authorized Agent S e-OTT 611ISS o wJ
City NO L.Ownhi Vqr�J►c_o ZIP ; 2_9 Z
Affected )<CW ❑EW ❑PTA XES YPTS Ac.,c T Phone # (?4.T):24o - ?5Zo River Basin LKKVr_P_
ElOEA ElHHF ElIH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body A I W M/ at /man /unkn)
❑ Pws: iA I W W
-� C�Inccct Mai Wtr Rnriv
�o i � � t � Soy►,.
Agent ppliPrint
Signa re ** Please read compliance statement on back of permit
$' 400 --0; 4(v0&
Application Fee(s) Check #
IYLER MCCLkIIze
Permit Officer's Print d Name
Signature or
s 7 2v19 9h zol
Issuing ate Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: i e r, 0r t- � (S7`e-S
Mailing Address: 1O 7 OX-Ard
z7511
Phone Number: 7 099e'
Email Address: ka` `'' �- �� yvxa 3 j m
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: F I C -60 1
at my property located at (AL
in �,L County.
I furthermore certify that ! 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.
(10�orrty Owner Information:
Signature
Print or Type Name
0 CJ & er
Title
1 710 I -Z-0 1
Date
This certification is valid through 1

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIOWWAIVER FORM
Name of Property Owner. Kenton and Barbara Green
Address of Properly: 646 Ocean Blvd West, Holden Beach, NC 28462
(Lot or Stfeel #. Street or Road. City 8 County)
Scott Gibson, Waterbridge Const
Agent's Name #: Mailing Address:
Agonts phone rk 943-240-2520 3123 11 WY 17, Murrells Inlet, SC
29576
I hereby certify that I own property adjacent to the above referenced property. The individual
apptying for this permit has described to me as shown on the attached drawing the devebpmeriL
they are proposing. A description or drawing, with dimensions, must be provided with this letter-
_ _ --I ha%c no objections to this proposal. I have objections to this proposal.
If you have objoc dons to what Is being propasod, you must notify the Dh-hum of Coastal r/anagamant (DCU) In
writing within t 0 days of receipt of this notico. Correspondence Should be mailed to 177 Cardinal Odvo Ext.
Wilmington, NC, 28W5-3845. DCM rvpresentroves can also be contacted at [phone], No maporue is
considered the same as m objection it you have been nottAod by Cordtlad Mail.
WAIVER SECTION
1 understand that a pier, dock, pilings, breakwate use. A, or groin must be set
back a minimum distance of 15' from a of n n access unless waived by me. (If you
wish to waive the setback, you must ini ropriate blank below)
I do wish the the 15' setback requirem-thh�,` Not Applicable
I do not Wish to waive the 15' setback requirement
roe Owner nnadon)
Sig-nalure
Kenton Green
Pint or Type Name
107 Oxford Creek Rd
Mailing Address
Cary, NC 27519
Cdy/State/zip
919-637-0880
Telephone Number
4/7/2019
nate
(Adjacent Owner Information)
/1/72 r
Signature
�Zp'1r,3,gC(, /(11Xit
Print or Type Alamo
l-fwc -twZth49 J-11(w AJ
Marling Address
CCU "%, ,tic, f,7f l b f 14.I-0c." roc lww A-, zSy4 r
Cityistat
Telephone Number
C P
Date
Revised &i S2012

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Date Received
Date Deposited
Check From Name
Name of Permit Holder
Vendor
Check Number
Check
amount
Pem it Number/Comments
Recel t m RefurmMeallocated
Columnl
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Co1umn4
Columns
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ontract m of C roh,as LLC
Kenton Green
S late B,nR
00. 0 GP#74241D