54436D - Khan

CAMA / DREDGE & FILL
BEN ERAL 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
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC//. �L oG
�y ules attached.
m it Nae �'/ <'/[ Jl ` 4 l �i F .J Project Location: County 61(Zv,*S ev , C k
C% -3 1 eg ?UN P2 , Street Address/ State Road/ Lot #(s) s/9 /7-;7 Z—
at �
(Y 0�.; Dr> DH Stater C ZIP
� (9/9 )7 Fa�x # ( )
;
zed Agent k v����T �Gcy P -�a, PCs e
j CW SEW -.PTA -ES ❑ PTS
❑ OEA ❑ HHF IH - UBA ❑ N/A
❑ PWS: ❑ FC:
yes / no PNA yes / no Crit.Hab. yes / no
Subdivision
City
rFAlN
Phone # ( _) n ^River Basin L, I "r e
Adj. Wtr. Body Cam.✓ O �lG✓ 4V (nat ,
Closest Maj. Wtr. Body 4V w
if Project/ Activity /' y r c i LG/ / 7 i%) f' c'`d
(Scale:
Eck) length /-
i
ength
ember _
ad/ Riprap length
ig distance offshore
iax distance offshore
:hannel
jbic yards
imp
'use/ Boatlift
Bulldozing
Azgf I6')e
le"eC6i A- JL v 7
ne Length
not sure
yes
no
gs: not sure
yes
00
>rium: n/a
yes
ono
yes
(no
Attached:
yes
no
ling permit may be required by: /70[,CI Pam/ O�aG/� ❑ See note on back regarding River Basin

96' CANAL
1, 500'
TO AICW
17' - 16' - I - 17'
i
XX 16' 81+9
ALUMINUU----v
RAMP
PROPERTY OF
CHARLES HARMON
50-
PIER FOR
MARTHA KHAN
143 TARPON DR.
HOLDEN BEACH, NC
EXISTING
16'X16'
SEATING
PROPERTY OF
THEDORE RIVEN ARK

RECEIVED JAN 2510a0
RMIN
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freer
Governor Director Secre
AGENT AUTHORIZATION FORM
Date: 3 -�o ROWBOAT SeN1Sinthe
ce 1
Dock & Dredge
www.rowboatcompany.com
Name of Prouerty Owner Annlvina for Permit:
/i%zv-/-� z lL 0�f/ Morgan Lane
Operations Manager
Mobile 704-90
Mailing Address: The Rowboat Co., Inc. 704-66
x— 858 Williamson Road Fax 866-64
(f-3 /� !-v Mooresville, NC 28117 mlane@rowboatcompa
1X1dR"V I3, .a-
Phone Number: ( O) 9//J—
I certify that I have authorized (agent) (W&61 r 66z*- -tbnc� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
construct (activity)
at (my property located at) 3 17
This certification is valid thru (date)
3—/—/0
n�

66-30/531 2491
Mushtaq H Khan ass
Martha S Khan
725 Ocean BW W. DATE ^ 2 ��
Holden Beach, NC 28462
PAY TO THE --J $ C7�
ORDER OF-�- r
e� DOLLARS x
I,�A tor. Micro Print sip aturc line, gr,} qpe and linework. FI st citizens Bank logo on back. I( not present. do not cash.
First Citizens
Bank
firstcitizens.com
FOR 1 -.-7A%
1:053L003001:00 6552061?111' 0249E

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ 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:
Uzi IV� ?`�YrJ �&', /4/
(X ��
❑ Agent
—
❑ Addressee
B. Received by (Printed Name)
C AQLC-5 FHWP o►J
C. D to of Delivery
j ��6110
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below:
-'p No
/ / p 3. Service Type
( 4 / 7j (l �� -Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number ���'j 1 �` �S fc� �� C/ z4�71 4K
(Transfer from service label) l V !j
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ 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:
�r�GU06�k� izlvc-vo4(1-L—
�f T l �-Pw�1 DtL
X 1 ��/ j 0 L 1 Agent
( C /� ❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑Yes
If YES, enter delivery address below: KO
3. Service Type
`Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes