White, Michael

F CAMA / ❑ DREDGE & FILL N9 78941
^ A B C D
GENERAL PERMIT Previous permit#
©New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r/ r
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name �, ( I �+ J .'-9 I� f Project Location: County
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Address Street Address/ State Road/ Lot #(s)
City State/ l ZIPf�nl
Phone # (' )r'
Authorized Agent
Affected 0 CW
AEC(s): ❑UEA
❑ PWS
ORW: yes / no
E-Mail
„ 44
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❑HHF ❑IH ❑UBA ❑N/A
PNA yes / no
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Subdivision
Ciri t 1 ZIP
Phone # ( ) River Basin-
Adj. Wtr. Body 1 ( 1, " ;/(hat /man /unkn)
Closest Mal. Wtr. Body
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.Agent or Applicant Prined Name
Signature''Pleas read compliance statement on backiof permit z•
Permit officer's Printed Name
Signature
i
Issuing Date ' Expiration Date
Application Fee(s) Check#

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date 7 l -7
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) 1r's<Co T/ 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) 20 7 S120,nlleej V/
This certification is valid thru (date)
'71 Z
Owner Signature
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
'hereby certify that I own property adjacent to / "/ /I f &A / Y F— 's
(Name ofProperty Owner)
`t�� t- n
xoperty located atd. l H"7?i--""��.j'�4J w/il'i
(Lot, Block, Road, etc.)
in ,,/
��t '6 aS I-/? 6j N.C. �(Vv
(Waterbady) (Town and/or County)
Applicant's phone#:zS`Z- >e 7 g�Mailing Address: $-OZ - zolc- 14A-fQ�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. (�
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filed in by property owner proposing derefopment)
(—� AreA
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C%b(JFI' 1(7 t'( tdf'/
,(re pflo12.
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(faformation for Property Owner Applying
for Permit)
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Marling Address
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City/State/zip
zc'z_—G�`ro3
Telephone Number
"gran Date
ty Owner In atiA
Signature
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FUMM

I hereby certify that I own property adjacent tY "�11 �s� 's
(Name of Property Owner)
property located at -12 zL'� v�o✓Cv,PaJ 9/,, Nt-J , A) z
/ // (Lot, Block, Road, etc.)
on W,sC� iee,(C &"y- , in ^J2LA! N.C.
(Waterbody) (Town and or County)
Applicant's phone #: � 5 '90TAlailing Address:
J ice, ✓ Ze" AC
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filler( in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
,� ! uw &.,4 de zss6z
City/State/Zip
25-2— 6zs--9o33
Telephone Number
�7f d/q
1 ature Date
I
(Riparian Property Owner Information)
Zig�nature
Print or -type Name
Zu' z_--- G26 `3 `P,FIl
Telephone Number
Date