White, Julian J.

®❑CAMA / ❑ DREDGE & FILL t l ( NO. 74406 A B C D
ENERAL PERMIT Previous permit#
i
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environwntal Quality
and the Coastal Resources Commission in an area of en ronm tStal concern gursuant to 15A NCAC '
PRules attached.
Applicant Name A,�. �;{' ! " Project Location: County -
Address /-( W"" + Street Address/ State Road/ Lot #(s)
City(-_k� /
I
L State ZIP
Phone # (
/
E- Mail
�' f
Subdivision
(.'
Authorized Agent
J
City
DCW
❑EW
❑PTA ES
❑PTS
Phone # (� )_ River
Basin
Affected
AEC(s): ❑OFA
❑HHF
❑IH BA
DNA
Adj. Wtr. Body -
_nat_-/man /unkn)
g
❑ PW
ORW: yes /
PNA
yes /,n.
Closest Maj. Wtr. Body --
--
Type of Project/ Activity
L i (, -
(Scale: (✓A,_
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshc
max distance offsh
Basin, channel
Boat ramp
Boathouse/
Beach
Other
Shoreline Length J .�
SAV: not sure yes (ng—.—.�--
—
-
-- --- -
Moratorium: n/a yes �iio.;'
Photos: yes do —
Waiver Attached: yes / no..
A building permit may be required by: 1,,. \_ I I J [
%t
❑See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) J ]
Notes/ Special C nditions -� [ I �..�
o
Agent or Applicant Printed Name
PermitOfficer's Print el' Name
Signature a+ Please read compliance stateme ton back f eermit** /
Signature
) -
Application Fee(s) C
eck#
IssuingD to
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _ jJ Ua/AN J • wNlff
Mailing Address: 3906 GoNTely 79/v(
6ge-6NVILLF A,16 2 7g S8
Phone Number: SS Z — S6 ( — 6S66
Email Address: w,,/Id ' VAI � &1AI•1 . Co
I certify that I have authorized 11n ,e66 MVe
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
/JiWaz'//+,P c�Lj 50' DP �yI-X OD
at my property located at
in ��/`�JeE� 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 application.
Property Owner Information:
signature
Print or Type Name
Title
Date
This certification is valid through I f

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
p 1 ytlpN J - 10117E _'s
I hereby certify that I own Property adjacent to (Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on 6lri6f CAgX in N.C.
(Waterbody) (CityrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location,
f have no objection to this proposal.
I have objections to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must filt in description below or ettach a site drawing)
K)N4 ivoo
SvtIGHN� /'tiv,,SFv poop
/$D190fab Afa4&3(, sD/
'dp�c GR� iL
Ypa➢
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift or groin
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 1b' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Infofmatlon)
Dare
'Valid for one calendar year after signature-
(Adjacp'tProperty
�Owner Information)
Signature•
Print or Type Name
SOS 6 r aR v c^r
Meiling Address
F�EH✓Fv�--r-- N a- aySi G
CitylStalelop
3r?6-57 6-45'37
Telephone Numberl email address
'2-/I-t9
Date
(Revised Aug. 2014)

... ,,., eonPERTY OWNER STAIMMYT
p01A�ENT KmF•r•rn
VLrpN J WuIT s
1 hereby certify that 1 own Property adjacent to (Nano of Property owner)
property located at Zo GiXss C• Fr
(Address, Lot, Block, Road, etc.) N.C.
in Xf` nvin,IeT
on //Txf Cliff (City/Town and/or County)
(WaterbodY)
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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till In description below or attach a site drawing)
F,rsArt u''o l;/laopSfv F,AbD
iSr�K7+N�
}/ousF x� Mpµsq �,IK6S
rp�➢
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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.)
UtA S2 I do wish to waive the IS' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature _
Print or Type Name
3909 LANiANA "pRIvF
Madmi; Address
6p vvito NG Z785"B
C,ry/Sfafe2ip
'V; _ 561 - 6Soo
Telephone Number/ email address
Dole
(Adjacent Property Owner Information)
kf
i tl
(Revised Aug. 2014)
`Valid for one calendar year after signature'

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