41931_GREGORY, WILLIAM_20050616

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i.CP.MA / DREDGE & FILL
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GEN ERAL PERMIT
Previous
Previous permit #
i_7Nevv -1Modification !_!Complete Reissue IIPartial 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 environmental concern pursuant to 15A NCAC
❑ Rules attached_.
Applicant Name <­ %'i / % t Y--7
Project Location: County
i
Address . ip r7 01Y X r �: i �+�`ti � ��
Street Address/ State Road/ Lot #(s)
City v ��i"+- ..�FIL E/1 Sae IV( ZIP
/' -: �{ T.- A, A-
Phone # () Fax # ()
Subdivision
Authorized Agent
City ZIP
- CW E�EWTA El ❑ PTS
Phone # O `� L`r/ River Basin A
Affected
OEA HHF ❑ IH El USA N/A
AEC(s): LiElAdj.
Wtr. Body -:",;�'•''( �%' ' ' � �' !�(nat /mao='/unkn)
G PWS: ❑FC:
ORW: yes / no PNA yes / Rio) Crit. Hab. yes / no
_
Closest Maj. Wtr. Body -
Type of Project/ Activity
(� •
(Scale: )
Pier (dock) length
_
Platform(s)
Finger pier(s)__
Groin length
--
number
.. — - ---
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
;
cubic yards__
Boat ramp
Boathouse Boatlift�,
Beach Bulldozing
y
Other
Shoreline Length
SAV: not sure yes ho:
{ �X
Sandbags: not sure yes ,no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
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❑ See note on back regarding River Basin rules.
Special Conditions
Notes/
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name

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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
n Tar - Pamlico River Basin Buffer Rules ; Other:
LJ 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax:[phone]
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)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

AI)J ACENT RIPARIAN PROPERTY ONWNER STATEMENT
(FOR A PIERIMOORlNG PILINGSIBOATL/MBOATMOVSE)
I hereby certify that Y own property adjacent to J�y�faa�=
(l� a"le of Property V ner)
i tai at
propenY, � o I
Blork, o:►ti, etc.)
N.C.
in_ ----
on (Waterbody) (Town and/or Couttfy)
He has described to nee, as shown below, the development he is proposing at that location,
r osal, I understand that a pierlmooring
and, I have no ob�ecttons ehis pup
p'tiings't�oatliftlboathoust must be
set t back a rr.in•n, .urr: distance of fifteen feet (DS') t-rom my arts
of riparian a.eess tinless waived by me.
) dpo, wish to waive the setback requiaeinent.
t IU vaish to waive that setback require"Itnt.
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r)"CR1PTlON AND/Oil DRAWING OF PROpO5kD DEVELOPMENT,
(To be felleel ire by iordividual proposing development)
AYit,�r
N,
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S:gr�:�ttire '
Print OrType Name
i'elephone Number
Date. �'

ADJACENT RIPARIAN PROPER'I'y O�a ST vs�NT
(FOR A PIER/MOORING FILINGS180ATL
Y P ��f, .—
I hereby certify that I own property adjacent to Nsnre`of p�o� -wn )--`—
�r C ✓
proper) ;tcatcxi at (l.M, Block, Road, etc-1
in f ass Z
on (�i'alerbady) (?own ar+d/or County)
He has described to me, as shown belc�v. the development he is proposing at that location,
esal. I understand that a pier/mooring
and I hove no objections to his prup from my area
p;hngs"boatlift/boathmse must be set back a srin:murrz distance of flftCen feet (IS )
of riparian a.c:ess uniess waived by me.
I Wish to waive the setback requirt!fnent.
t% I wish to waive that setback regtaireinent.
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.................
- RAND/O-- DRAWING OF pROPOSED DEVELOPMENT:
r) .SCRIP YIO
(To be filled in by Individual proposing development)
9� I
troPos�d
I I
® 0 \x+ .._..1
64-
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-_ - - - ..
10 ------ ------­-­------------
Signature
Print or Type Name
Telephone Number
r—

MR. OR MRS. WILLIAM GREGORY
6668 OLD LEXINGTON RD.
WINSTON SALEM, NC 27107
66-987/531 2546
0003
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DOLLARS°^a°F
LSB Beeline el Bankin sm R
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Lexington State Bank f ///�
Midway, NC �]7107 ;(1 { ( J�
MEMO
1:0S31098771: 000304836EO 2S46