White, Glenn H.

lACAN%A PEI DREDGE & FILL
NY% 67566 r A B
GENERAL PERMITPrevious permit #
�New ElModification ElComplete Reissue 0 Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmentalftoncern pursuant to I SA NCAC rh_� t1ri
s'a chi(d.
Applicant Name 1)
Project Location: County
Address Street Address/ Stite Road/ Lot
If(s)
City State ', ��'Z IP
Phone # 11, -Mail l Subdivision
City k' Authorized Agent ZIP
N&C 'w A -vier asin,
It, Affected El ES 0 PTS Phone # B
0 OEA 0 HHF PTA
0 USA El N/A AEC(s): ❑Adj. Wtr. Body Anat /man /unkn)
11 Pw.s,: iq
Closest Maj. Wtr. Body yes n P NA yes 1a0
Type of Project/ Activity i�") �..d k�
•' . I'
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore—
Basin, channel
11■■11■11H1111111.11111■11■11■1■
91
■■1■1'■■�1►��■1■■■1:::1CIl1111111�1111111■�i11■��111��1�1::■1:1::■C���:■■■11'
cubic yards
Boat ramp
Boathouse/ Boatlift
:
4�11111
Beach Bulldoxing—­'
■,..».L,..■.,.....,.......1.....�....■
11111:11C�:1:1;�1��::1��1111:���1111:11''1:1::
A building permit may be required by: I f
Note Local Planning jurisdiction)
Notes/ Special Conditions
&
Agent or r Applicant. Printed Name J
Sft9ature-, Please readcompliance statement on back of permit"
r
"'ApplicationFee(s), Check
L_J See note on back regarding River Basin rules.,
m tofricer*s Printe 'e'
a
J i
Ttre
iin Date
Expiration; Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules ❑ Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastalmanagement. net/
Revised 08/27/ 14

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: fi . G t e. h n lO L-- .'A -
Mailing address:
C .I N C
Telephone Number: q ► q - 1030 - �+ 94 F
I certify that I have authorized _-De r e (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of -?a* cf -
at my property located at
�C
This certification is valid through S�1 v 1 2 o 1 to (date).
(Property Owner information) o
Signature No5
EIVED
Print or Type Name
Title, co. owner or trustee for property
Date
I'S - to 10 - -- g 5-4
Telephone Number
Email Add�'fess
JUL 2 9 2015

DJACENT RIPARIAN PROPERTY OWNER STATEMENT
I, hereby certify that I own property adjacent to I -I G-1 �P_,n V% W 11 1 + 49-- Is
(Name of Property Owner)
property located at 3o t 0a k v . o wr
tqc—
(Address, Lot, Block, Road, etc.)
on�t- S—. , in Ipe. rtl,ecA [ 4- , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc ti n.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing'development must fail /n description below or affach a site drawing)
1JQB. Att-aC� eJ
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse Aptigroin
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,) 291015
jut
I do wish to waive the 15' setback requirement. ,°,"Xr�h��
I do not wish to waive the 15' setback requirement.
Z
rty Owner Information) (Adjarr
rtyOwner Information)
Signature Signature * net.._ _...
or
la - t
Date
l..i h.��1.•. �A�Q�11N
"Valid for one calendar year after signature"
Print
qa2 c
Tele hone Number/email address
9:7 / 1 1-2-
Date— I
(Revised Aug. 2014)
Zbo

'Vaud fit' am coorAW 'ym sftw sWoWW

4
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 14 . G (e,nvt W t.. + -P— 's
0. (Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.) ' .
on �o ue _ So.1 ,.,c�' , in tp prc1%ec al r '. I, , N.C.
CZ (Waterbody) (City/Town an/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
Se-2 AttaC� Qci
WAIVER SECTION I
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grdW
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.)
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Pro Mrty Owner Information)
Sature ie
C, le LL
Print or Tvae Name
C. 'Z
City/Stat 2Aw.,�
Telephone Number/email address
li -tS IS
Date
(Adjacent Property Owner Information)
Signature
694AAM57R
Print or Type Name
70 EAMEL[_ ST—
Mailing Address
City/State2r
SirDZ"Lte/E2�tO6. twdu- cps
Telephone Number/ email address
Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature*

&0'
No t for Re cording N
S�
� " � � / rocFs o`'
'91�J ♦ / ARFNa sT e���
� I � C� � / F<< Sr • F�,T F
CY) A
♦ ♦ C NAIL & CAP / AND OR
BOG SITE o
U
Z N N
D6
Q�
N D
� o1� e3�673 00 O wo°°02c
pG4p°64 oVICINITY MAPoCl)\ v NOTTO SCALE/�\Mpoee
EIP 3 OkZ(pp1
4q14 \ \ /3k630.
0�
O v
Iry
'ZI
v ♦, \ o \ 32` ♦ \ � �
` O� / ♦, / \ \ \ O ♦ 2"EIP
O ,
3`3 p � pp ' / °,•
IR
`:rS22do
C qq/ a /
oq' ti
♦ / 2n0
♦ (nF / v/ Q
EIP EIP 00•
ACREAGE s� 2¢/ / O ::� / / / �� SIR Q� CO
BY COORDINATE METHOD �` //CP / / / 19 / / 62 orr°r EXISTING �Q� `b o�
126579.62 S F. = 2.9 0 AC . }/ / V� / / 18 / / S8 J ANGLE IRON J\ O� A
k.
o, CV
cV
Sz
/ NHWL
SIR O
LEGEND: N 8
EIP - Exsting Iron Pipe 0 _ L / v� 0 2331,,w .�
E RM Existing 1 Pipe Monument ❑ 3 sfi► D /� 4 i 53, .. L _1 s
EPKN - Existing P. K Nail 0 %
ERRS - Existing Railroad Spike 0
- E et Ira Axle 0 SIP
SIP - Set Iron Pipe O f�
SCM -Set Concrete Monument ❑ ^,
SSN - Set Survey Nail 0 M
CL - Centerline
C.P. - Computed Point
R/W - Right of Way
R - Radius
A -Arc
MBSL - Minimum Building Setback Line f
Sq. Ft - Square Feet 1 D ' / Z
MB - Map Book
DB - Deed Book N `
AEC - Area of Environmental Concern
NHWL - Normal High Water Line
LINE LEGEND: X— X X— X— x— X— x— x— x—
Long Dash With X = Chain Link Fence - E — E — E — E — E — E — E — E
Long Dash With E = Overhead Electrical Lines -
Solid Line = Stationary objects (i.e. buildings, pavements, curbs, sidewalks, etc.) - — —
Long Dash With Two Shorts Dashes = Boundary or propertpbnes (e@ftr+g•er p►epaee*-- — — — — — — — — — — —
Short Dash = Setback lines, ajaoent property owner lines - — —
Long Dash = Easement lines and proposed or adjoining4ettinetwithinaamevreper4-ersubd v*w -- —
Long Dash With Short Dash = Center lines of streets -
■■■■■■■■■■
■■■■■■■■■■
SSN
SURVEY FOR
Glen White
209 Oaksmith Boulevard — Morehead City, NC 28557
Deed Book 577 Page 495 & Deed Book 751 Page 974
Map Book 1 Page 259 A & Map Book 1 Page 13
PIN 637613025643 & PIN 637617024273 & PIN 637617023227
Surveyed By
e4� & qe o�
Professional Land Surveyor L-1079
Post Office Box 310
Morehead City, North Carolina 28557
Telephone [phone]
Email: [e-mail]