Gray, Ervin

®QCAMA /DREDGE & FILL 00 I(i No. 75958 A B C D
GNERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality —7 Y Z� 1 (C,
and the Coastal Resources Commission in an ar a of environmental concern pursuant to 15A NCAC
/ �. ❑Rul sattached.
Applicant Name Project Location: County t
Address
j
City (t�State-/%(
�'/
ZIPPhone#
/` Vr'L
O
E-Mail
Authorized Agent
Affected ❑CW
OEW
❑VTA El ES ❑PTS
AEC(s): OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: /yes /ino
PNA
yes ///no /
Type of Project/ Activity
Pier
Fix.
Float
Fing
Groff
Bulk
Basin
Boat
Boat
Beac
Oth
Sher
SAV:
Mo
Phot
Waiv
Street Address/ State Road/ Lot (s)
•
Subdivision
city
�f/�✓/'�.,, %J//ZIP
r/�
Phone # (_) Ri er Basin -
Adj. Wtr. Body f C Kat /man /unkn)
f _>
Closest Maj. Wtr. Body ' yl 5 ,.`. 1.
(Scale: /1 j. -I/", )
■■■
■■■■_
v■■■■■■■■■■■■
NEE
■■■■■■■■■■■■■■■
■■.�MEMM■■■■MOM■�■■�
MEN
�EMEN
■■■■..�■■.
MORE
MEN
OEM
M
■■EMEMENEMEM
�■�0■N��■���
length
■■■■■■
■■■■■■■■■■
■■■■■■■
■■■■■■■number
■■■■■■
n
■■■MM■■M■■■■■ME■■M■■.'
MEN
■■■■■■■■
MEMO
■■■
■■M■■MIN■■IS
M■M■MO�1■■��■■■■OMM■■MO!!■■■■■■
ONE
avg distance offshore
�EN���IJNM
Mfl
lM
OEM���■ME■�vME�
�no�
max distance
E■■E■■■E�
�■■■■■■
OEM
■■uE■■o
MEN
■
■ERE■■■■E■■■E■■■■■■■■■EOM■M
MEN
■MOM■■EME
■■■■■■■
■■■■E■M■■M=EE■uM■E■■■■■�E■■ME■i
EMMEM■M
MMERE
Mrs■■OMM
ME■IY
VIA
ON
cubic yards—
■■■■■G�Mii(�■M��MME■■.M�■EE��■REF
ME
■■M■Y■■
ramp
■■■■E■■■■E■M■■MORE■■■■
■■■E■■■E■E■■■■■O■
■■M■■■■M■■■■■■
E■E■ME
I�iM
MEN
iCMi
ME
Nor
■....�iMEi■ME
■..CBulldozing
■■.■�■■No
.■�i�'
Nor,
Ex
Emu
No
�0
■■■MEME0MEN
M�M�■ENE
Miiwiin�■i
iA
iEiiiiM
i
�iSrriiiii■■
rAw
:N��::MIN
M::EFit
'INN,0
MOOR■
►AIMMEM■Mr■u�y
MO!®HIMiJII�I:�EM
'INN,
EM
a
Moll
ME
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name Permit0 r1 er, Pr(nt
Signature ** Please read compliance statement on backofpermit** SignatV-)
EJuI(kI /`i
Application Fee(s) Check# Issulng ate
il.
q `'
Diration Date

rr�
30�
d/©
4 rr.
3f
RECEIVED
NOV 15 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
prc
on
The applicant has described to me, as shown below, the development proposed at the above
location.
---> I have no objection to this proposal.
_____ I hav-e-obj-ections to_this_proposaL___
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Di5 50-" ouj o-P kc>aA ba�5)N
DECEIVED
NOV 15 2019
JeAA e DCM-MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Cit /State/Zip
a)-5a4-g148
Telephone Number
In •
Date
(Adjacent Property Owner Information)
Signature
wl(_C_«t
G2/9 �r L7_C
Print or Type Name
aQ 144-«ye)
Mailing Address
ti- I ry 5 q�o
City/State/Zip
Telephone Number
Id-K -/a
M
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I
I hereby certify that I own property adjacent to
property located at
Owner)
(Aaaress, poi, esiocK, ecoaa, ecc.l I
on PA l il[i in I+arKerS Ts��d N.C.
(Waterbody) (City/Town and/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.
__ --- -__ ____—j-4a-ve_QbjQ.oIion-s to_this-proposaL-------------_--
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Re.pca t s S1-oc- In cla m�� ed �i e s-.
RECEIVED
FRP- NOV 15 2019
DCM-MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
or Type
.A853a
Telephone
(Adjacent Property Owner Information)
Signature
rXi r,--TI—
Print or Type N6me
2/0 i✓/ / Gi-cvr ^/ J 1/C-
Mailing Address
A'e./ terry N 2d'S�L
City/State2ip
a 5 2 — 229
Telephone Number
/ems --- C — / 9
Date Date
(Revised 611812012)

CAMA / DREDGE & FILL N? 40040
P ENERAL PERMIT - �-
Previous permit #
ew ❑Modification ❑Complete Reissue ❑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 environmental concern pursuant to 15A NCAC 7-11- 15O4
❑ Rules attached.
Applicant Name 'OCrVf �J 6raY
Address D fjO}r jl��
City 1 r7t-1 AJ State NC ZIP 'a8530
Phoni 5a2V -' is1Y Fax # ( )
Authorized Agent
Affected El CW I1 EW EOTA ❑ ES ❑ PTS
AEC(s): El OEA ❑ HHF ❑ IH ❑ USA Li N/A
❑ PWS: ❑FC:
ORW: 6 es 1no PNA yes /6) Crit. Hab. yes / no
Type of Project/ Activity ���/�l tIA U( Pl%i Au
Pier (dock) length
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length -,
avg distance offshore
max distance offshore
Basin, channel 46 K.25X
Project Location: County (241--r4IZ6 7-
Street Address/ State Road/ Lot #(s)
-7/ 4
Subdivision
city 44L-eke,-5 .15, ZIP
Phone # (�S7 River Basin AV eAk
Adj. Wtr. Body#NA/i06C�ma /unkn)
Closest Maj. Wtr. Body �&gd .: Oevo
.�5'xy' "(i7o«
cubic yards Qu Y4)S
Boat ramp R E C E
Boathouse/ Boatlift 1
Beach Bulldozing NOV 1
Other
CCM-MHI
Shoreline Length N
SAV not sure yes
Sandbags: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
tj't/ace
r%fvf,
A building permit may be required by:
Notes/ Special Conditions
'�:p'),/ Ir-
f/ f/AC K S OU/i D
rfpf' ec(
�/ AlLWy �ti / E
(Scale: A) T" S )
Mw0iirort 4t-da
x/sr[N9 I
I�o
`°"'-TL r`e.14 ❑ See note on back regarding River Basin rules.
It:�',ptiE,, af- 4 �16' 4a1- t Alll-f/ fo P/edPN'/ e-� A
ur,viuoi -/� fYe 1 a5/l u, 5 -,o6;1 o<a ie .iaL lea/ /9-6 r
U�, 0rm
Agent or Printed NamePrinted Name
���
Signature ** Please read compliance statement on back of permit**
/00 � # y507303'��f8OD # y507303441
Application Fee(s) Check #
-15-OS
Issuing Date Expiration Date
C'wr�e�et �/ols/7R
Local PlanningJurisdiction Rover file Name

r� FO-1 r
-5)
e ,- v) /,' 4- pwr� G.,-,z7
'7(S Y�slq ad RJ
AJ,e
SI-�d V-C,