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North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee Fre
everly Eaves Perdue James H. Gregson Sec
i
Director
overnor
AGENT AUTHORIZATION FORM
Date: i
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
wner's Mailing Address:
r i to &9,Ovti AOWUII
�ilGl�t I-�o�b VA Z3 n,9
'hone Number
Agent's Mailing Address:
j3�R�1. Z�SSorT I�Orn� aG 7� /1G
2 o 2 .S o v rt r~
Sur C 29YYS
Phone Number (90 1 3 2 Y- D 23 i
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
`or and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at
m l NSW f�t vg- � I- KIT
This certification is valid thru (date)
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State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
Beverly Eaves Purdue, Governor Dee Freeman, Secretary
CO:
REMARKS:
FAX COVER SHEET
No. Of Pages: (excluding cover)
From: 5&h
CO: Division of Coastal Management
FAX#: [phone]
127 Cardinal Drive Extension, Wilmington, N.C. 28405.3845 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer

5
.FCAMA / DREDGE & FILL
3"ENERAL PERMIT Previous permit# '-
\New Modification Complete Reissue ❑Partial Reissue Date previous permit issued ---
rized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 74 . 12-EJc%
❑ lules attached.
it Name J-E&N F. R-E-D Project Location: County
-�-3 10 r­;�CVe- AVt/ . Street Address/ State Road/ Lot #(s)
OMCN I) Statek,,A ZIP Z75,Z-Fo ' J 1 N of
fo-) -443 S+Fax # ( )
ad Agent NAl Kll�&
CW }�W PTA ES PTS
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/ no PNA es no Crit.Hab. yes /(fio
Subdivision
City Kog-*- 7N,15-Att, bQ+- ZIP 4%
Phone # "— 7�,-�107!!;- River Basin W*
Adj. Wtr. Body `J'C' e ric L)A > 4M
Closest Maj. Wtr. Body '9rlJ ew P �*w
bf Project/ Activity ccn-�44- ✓,2L10
(ScWe: Cr'
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length
iumber
-ad/ Riprap, lengt1h_
,vg distance offshore
-nax distance offshore
channel
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ding permit may be required by:S� f� /����Qe note on back regarding River Basin

Acant: , �� � ,�t�D Permit #:
-7 5 tos
>cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
�itat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other Vh
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Postage
$ $0.44
Certified Fee
03
$2.85
Return Receipt Fee
>rsement Required)
Postmark
Here
$2.30
Mated Delivery Fee
wsement Required)
i�.On
59
at Postage & Fees
10/11 /2011
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Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
.o(Domestic
— rl
Mail Only;
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! For delivery information
visit . ur website at %vww.usps.com,,,
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Postage
$ $Il • 44
04t50
- ro
Certified Fee
$2.85
03
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Return Receipt Fee
(Endorsement Required)
$2. 30
Postmark
Here
0
Restricted Delivery Fee
(Endorsement Required)
$0.00
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Total Postage & Fees
$ 55,59
10/11/2011
Sent To-
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KING WORLD ENTERPRISES, INC.
ACH R!r /5300198
66-19/530
BEACH RESORT HOMES OF TI, LLC
BEACH SIDE REALTY OF TI, LLC
1
202 S. SHORE DRIVE SURF CITY, NC 28445
—
910-328-0239
THE NC Dept of Environmental & Natural ResourOF
*#
ORDERPAYTO
Two Hundred and 00/100..#,.....,.......***.#.....«...«****«**.*,..,**..,.#.»*.**.*...**..**..,..*.,.*.*..*„
NC Dept of Environmental & Natural Resour
Division of Coastal Management
Vold arrer so I
127 Cardinal Drive Ext -�
Wilmington, NC 28405 �(� �j'� 5(q (� n�
`
MEMO 871 New River Inlet Rd, NTB - Jean Reed
1180096 29119 1:053000 1961: 23?0054 L668 2119
KING COMPANIES-KINCO INC.
NC Dept of Environmental & Natural Resour
10/12/2011
Date Type Reference Original Amt.
Balance Due Discount
10/12/2011 Bill 10122011 200.00
200.00
Check Amount
�iP5�565 (ON)
1010. Checking Bank 871 New River Inlet Rd, NTB - Jean Reed

DECEIVED
DCM WILMINGTON,
NOV 0 1 2011
Beach Resort Homes of Topsail island, 11c
2o2 S. Shore Nve . Surf City, NC 28445
FAX TRANSMITTAL
f/
Attention:
Office: Telephone: [phone]
Telephone:
Fax: [phone]
Fax: 9'/0 -��qs` .396� Date: /1'/—.2-°' //
RE: 7'ea,11- -7 r
Total Pages ,Z

OCT-31-2811 13:51 From:
To: 918 328 35M
P.2.,2
r
RECEIVED
DCM WILMINGTON, NC
NOV 0 1 2011
yK"MA / u DREDGE a RU N° 5 756 5-P
C�GENERAL PERMIT fig N 4
fWw nModiflatlon E.]Complete ReluLm L-IPartW Reista OM pr.Now permk h wed
As Gut wtaed br tN $Wta of Nairch Cavana, 0GOOMn— Of EMIM— and Natum R2a0n:ar
and th6 CouW PAsoupw Commission In on ar t of KM *14, WN d _ KOM pur3uLnt to i $A NCAC'79 Z.p
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