72302D - Kinlaw

t WCAMA / DREDGE &FILL t
ERAL PERMIT
XNew _Modification ❑Complete Reissue ❑Partial Reissue
No 72302 A B C Q
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 t 5 O a
❑ Rules attached.
Applicant Name ']:),A1J K1 NLAW
Address 'Po Oax "1'09"1
City�,4 r-Y-rCV 1w r— State--AIC ZIP 283 Q 3
Project Location: County $R'q'A115w IC-r—
Street Address/ State Road/ Lot #(s) /0 3
6C r-,,,#J Wes-, VL v o
Phone # ( 910) ? 1 R - q 700 E-Mail ckhk;n Ay
e mare . co,..tSubdivision NSA
Authorized Agent
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City O�-F-sIN S t A cN ZIP 284 (Al
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Phone # (9t o) 3q 8 - Z(y 4 River Basin Fmr mg -
Affected
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ORW: yes no
PNA
yes / no
Closest Maj. Wtr. Body A IWW / Tess
Type of Project/ Activity RV-PL-A<-t= Sal- t 5-r1il 170cKIAIG FAc►u , y
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A building permit may be required by:
( Note Local Planning jurisdiction)
DGF4✓ 7T-51*- 1311A414 ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions O % #4 12 Ott & A 1.4r OTF 1 IE R L.O C-A t_ ST Tit T E.
A./4 D F F-4 Ejt A L- R E 6(A%-,aT r of)S A P PUY .
fit A) (�
Agent or Appl cant Printed Name Q
Signature ; PIS ease�read ompliance statement on back of permit
Application Fee(s) Check #
Mc GK
Permit Officer's Pri ed Name '
Signature 417
G 5/2ag to 151,7019
Issuing Date Exp tion Date

AGENT AUTHORiZAM—N FOR CAMA PERMr APPU'o
Name of Property Owner Requesting Perrnit:
Mailing Address:
Phone Number: ' gl r q �OG�
Email Address: . r► U` n �� M4 V Co'Yr�
I certify that I have authorized X�,�,- �i 1[�,r - ,
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:Q
14 n Al n w n n
at my property located at /D 3 (k- 'TsCe h -" f AI —(Id .
in ArgfiWjr'C�County.
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 apphwt on.
Property owner Information:
Signature
Print or Type Name
0 (-
Title
Date
This certification is valid through i

on
(CIWTown andlor
• • • :.rt•• • 1 - • •-• •: .
DESCRIPTION AIAMM DRAYAW OF PROPMED DEVELOPMENT
ffiWMAW WWoft dPV* gWW1t MU$tWfi Oftir below or aftch a S119 dra**jg)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwatef, boadwuse, fifi, or groin must be set back a
minimum distance of 1S from my area of riparian access unless waived by me_ (if you wish to waive
the se#badk, you must WU the appropriate blar* below.)
I do wish to waive the IS setback requirement.
I do not wish to waive the 15' setback requirement
SWA"e Signahffe
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1•
.,_- Date
(Rewtsed 611$/M2)

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Postage;£ Fees Paid
` I I� Permit No. G10
9590 9402 4909 9032 7795 00
United es
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SOUTH BRIINSMICX
117 SEASIDE � S -
OCEAN ISLE BEACH, NC, 2846 9 1029
366993-0470
[phone]
05/15/2019 12 07 PM==-==--
-----------------------
--------- Qty Unit
Product Price
. -
Price
----------------------
First-Ciass Nail 1 $0.� -
--
$0' 55
Letter
(Domestic)
(CHARLOTTE. NC 28211)
(Weight:0 Lb 0.90 02)
(Estimated Delivery Date)
(Friday 05/17/2019)
$3.50
Certied
tfs Certified Mail #)
(701806146618471}
$2 80
Return Receipt
(ASPS Return Receipt #}
(9590940249099032779500)
----
------ ----
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$ 85
Total:
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-
$6.85
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(Transaction #:028)
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