72797D - Sports

XCAMA / ❑ DREDGE & FILL
GENE_ RAL PERMIT
XNew Modification ❑Complete Reissue ❑Partial Reissue
A B C O
Previous permit #
Date previous permit issued
No. 72797
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 15A NCAC C 7 (� . 1200
SPORTS Cn/DCAyp� yAINESTMENTS LLt. ❑ Rules attached.
Applicant Name c% fSILL.y PARKS Project Location: County Ruwl5wt ck
Address 43 1 u 5 NWy '7 O A rASr Street Address/ State Road/ Lot #(s) 140
City ILLS 2 ou -,N State AtC ZIP Z727 8
Phone # (AA) 2Iq- 1411L E-Mail - A
Authorized Agent [AS CON ST%%&r 6AI — MAT-r HOW
CAA/AL l71Z I V
Subdivision NIA
City -SAA1rr_r SrACLA ZIP 28!4 to e
Affected ❑Cw XEW )(PTA ❑ES ❑PTS Ac roT Phone # (210) 880 — 43g1 River Basin (aA mRza
El ❑ HHF El El ElN/A
AEC(s): Adj. Wtr. Body t!,'/U/At. (nat man /unkn)
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
R 2.©0 4 Z2.55
Application Fee(s) Check #
__TYL-VR f4 C CA LA. IV_V
Permit Officer's Printed Name
_a
Signature
Z'M /.Z.O 7/ 19 /0141
Issuing Date Expiration Date

GIMA
NCt1ET�R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly 'caves Perdue Braxton C. Davis
Governor Director
AGENT AUTHORIZATION FORM
Date:
Dee Freeman
Secretary
Name of rope_rty Owner Applying for Permit: Name of Authorized Agent for this project:
ti e ;WA C t� H5 Construction, LLC
Owner's Mailing Address:
Phone Number L
Agent's Mailing Address:
2164 Holden Beach Rd.
Supply, NC 28462
Phone Number(910) 880-4381
r
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity): 4
deme ccMef iviStAll new c(oe(G , P«r u0t-i --F'Ioc.(-kr
For my property located at I q0 ;- o-) L. br.
o
This certification is valid thru (date) �� '� EeA j P et
)41fq
Property Signature Date

DM$M OF COASTAL FMAMAQVMW
ADJAC 4T MPARtAN PROPTJM �w!3
�H*TWCAV NlWAWM FORMN wocal: Pmpe* Omer.I � � ?OyV5 .1�,y�_IyWvVm _Lt C
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Motor b%VGt*, obw0ifte . c l +a calk*
Aug phone A � I � - 9 kO —4 3 F/ St�L� A � �.f N� - a
t h"by aatm fast I own pmPerty m0cw to
j bV fbr We pem* boo mUd to m me 4
ftwi Dave ea aNaotfona to tWS PMP08d.
Mumto What tobot
logo of mow of
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It gbow Wwftmd PMPO#V. Tho trtdiv 4W
qWMA on the a %dw dmft he d"lopowe
I hm ovocam to ft prQMIL
W none tE
WAIVER 6ICTION
I odwdmd that a p1er, dock, moodng pftobmiWAIMI, boaf K fM, or Wdn must be W
butt s minfam d ate = of IF fr6m my eM of dpaftn 6=W ude" vgbW by me, of you
%* to Weave the setback, you = t WN the appmpkte ihpk a.)
._.._...,._.-,,,,,,.,t aovVt�t�v�r�►tt�a �� uic rwqul�+�rwc►c,
1 do nO mfth to waive the IV eetbectc rapt mmont.
(Prop" Owner hftf ation) (Aom t fmpeM Owner t aftn)
Mc
Tale bona NumberlerWl address

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■ Complete items 1, 2, and I
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
_ or on the front if space permits.
1. Article Addressed to:
124-Wo d
VV
II l'Illll I'�I'� I �II I ('I l' I'll II I I I II�I�I'II
9590 9402 3999 8079 6803 32
A. Sign�ture
s 6 ElAgent
X ❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 17 U Yes
If YES, enter delivery address below: ❑ No
3. Service Type
t
❑ Priority Mail Express®
Q Adult Signature
Q Registered Mail —
El Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certified Mail®
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑- C fi j T.
2 Artinla w �..,ti�. r'%^^^� `--- - - )e ivery Restricted Delivery igna ure on rmat on
7 017 0190 0001 1320 7694 1 ❑ Signature Confirmation
.I Restricted Delivery Restricted Delivery
lover $500)
I PS Form 3811, July 2015 PSN 7530-02-000-9053
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