74335D - Kaas

IXCAMA / ❑DREDGE & FILL
GENERAL PERMIT
y�New ❑Modification El Complete Reissue ❑Partial Reissue
No_ 74335 A B C (.D
Previous permit #
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 0 7 N . 1 2`{JO
❑ Rules attached.
Applicant Name L41/15L 5 IKAA$
Address q 84 Co PAS RID
City SNA"OTT 6, State ZIP ;2 8¢70
Phone # ('1031) 943- 3662 E-Mail ar 8de%ne 2®msn. cow+
Authorized Agent W il" Rt C A AttvsarJ
°roject Location: County F,RN N S w 1 cK
Street Address/ State Road/ Lot #(s)
Subdivision e,— b �& l�
City ZIP
Affected ❑ Cw XEw )(PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body 5E1A,&O-r-rr_ RNr_VL (n� /man /unkn)
❑ PwS: .A I W W
ItiL. �C�I SLR
licant Printed Name
l\
J�
Signature ** Please read compliance statement on back of permit **
$200 4-746,2
Application Fee(s) Check #
Permit Officer's Print Name
L
Signature �0/27/ 9 I v��7A 9
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Niels Kaas
Mailing Address: 984 Copas Road SW
Phone Number:
Shallotte NC 28470
703-963-3562
Email Address: [e-mail]
I certify that I have authorized Richardson Construction
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Installation of boat lift
and dock construction
at my property located at 984 Copas Road SW
in Brunswick County.
l 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.
Property Owner Information:
Signature
Print or Type Name
Title
Date
This certification is valid through I I % %

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Niels Kaas ,s
property located at 984 Copas Road SW (Name of Property Owner)
on Shallotte River (Address, Lot, Block Road, etc.)
, in Brunswic� N C
(Waterbody)
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location,
initial here—7) I have no objection to this proposal.
I have objections to this proposal.
uC�
bloKi ' l IVN AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Modifications to existing docking facility and installation of boat lift
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the setback, you must initial the appropriate blank below.)
Initial here I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjac nt ProPe-dy Owner Information)
Signature Signat et
Will Richardson Authorized Agent
Print or Type Name Print or T e Name
3235 Seacrest Ave SW �yyp
Sufin SS
pply Ne-,28462
city/state/Zip
910-367-0335
Telephone Number
5-14-19
Date
Marling
6
Telephone Number
-�_ a�
Date
(Revised 61;812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Niels Kaas
I
property located at 984 Copas Road SW (Name of Property Owner)
on Shallotte River (Address, Lot, Block, Road, etc.)
, in Brunswick N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
initial here-� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
Modifications to existing docking facility and installation of boat lift
WAIVER SECTION
i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the setback, you must initial the appropriate blank below.)
Initial here �_ I do wish to waive the 15' setback requirement.
! do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Property Owner Inf rmatlon)
Signature Will Richardson Authorized Agent
Si. tuaha. Co'. S
Print or Type Name
3235gSAe�a�clresstsAve SW
Name
Pnnt ate—
Supply Nc: 28462
—
M icing Addre s
c- .7 6
Crty/state2ip
910-367-0335
City/ ate/Zip
'7
(O
Telephone Number
5-14-19
Telephone Number
%� ,
l 3
Date
Date
(Revised 611812012)

3q
IT�I� �li�
39
131

5hallotte River �S
Existing float
UIP
13x13 boat lift 12x1 bft -29ft
�44ft Stationary dock
s
�b4ft -35ft

Date Received
Date Deposited
Check From Name
Name o/ Permit Nolder
Vendor
Check Number
Check
amount
Permit Number/Comments
Receipt or Refund/Realkxated
Columnf
Column2
Co1umn3
Column4
Columns
Column8
Column7
Columns
Column9
7/3/2019
7/3/2019
Will Richardson/Richardson Construction
Niels Kaas
BB&T
7462
200.00
GP #74335D
We rct. 8757