54541D - Gregory

J GAIVIA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
New Modification El Complete Reissue El Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources -
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
t ules attached.
it Name 1 Q� �(I, Project Location: County E ,
State ZIP2-11_
7(rA(��f�s Fax #
��( )
edAgenQUA/�tayim Codria-bfl.
- CW �4EW XPTA ❑ ES ❑ PTS
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑ FC:
yes no PNA yes no Crit.Hab. yes / no
of Project/ Activity
dock) IengtV
irm(s)
r pier(s)
i length
number
ead/ Riprap length
avg distance offshore
max distance offshore
channel
cubic yards
-amp
souse/ Boatlift
i Bulldozing
Street Address/ State Road/ Lot #(s)
Subdivision-0 p,
Ci j p11 6 ( k , ZIP
%W4, (It) I River Basin
Adj. Wtr. Body
Closest Maj. Wtr. Body❑(ij-Sou 04
line Length
not sure yes Pn
_
ags: not sur yes T
s: �es
es no
r Attached: yes no
ding permit may be required by L-)r ,lll 1 Y&dA
(Scale: ' //
❑ See note on back regarding River Basin

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/tNOORING PILINGS/BOA' TLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to U is
(Name of ope Owner)
property located at
(Lot, Block, Road, etc.)
on 84ty7lZ �' /I + , in l7do/ - 6 50d 4w� V .C.
(Waterbody) (Town and/or C unty)
Applicant's phone #: l U',�•3,2 o63 Mailing Address:
�a►�y /s1a 11d) G o?yy3
He has described to me, as shown below, the Sevelopment he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
elevye-
etAd ReAty
old JJ 04
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`fir`, Pao
(Information for Property Owner Applying
for Permit)
Mailing Address
"g
y//
P-;,ed
(Riparian Property Owner Information)
Signature

ALITU-I'm
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
Name of Property Owner Applying for Permit:
MailingAddress: /
"'ell 0&
11��Sbx )
I certify that I have authorized (agent) �`� ' J /u7 to act on my
`n!l{ for the p4 ps .s.- Gc i4 ins fnr• and obtaining all CAMA Permits necessary to
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TIC Division of Coastal Mlgt. Habitat Impact Computer Sleet
Applicant �1� Permit #. 5q5`�
Date:
q fff�—
� -,?I0
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measure
found in your Habitat code sheet.
DISTURB TYPE
Habitat Name Choose One
OWI Dredge ❑ Fill ❑ Both ❑ Other ❑
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Artto: picle Addressed _ l
14row
S7Ul 06 Hwy 70
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or I and/or temp
TOTAL Feet
FINAL Ft
(Applied for.
(Anticipate
Disturbance
disturbanc
total includes
Excludes a
any anticipated
restoration
restoration or
temp impa
temp impacts)
amount)
A Si d
� ❑Agent
❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article 7009 2250 0002 7839 8097 —
(/iarrsterrs/er I►omseMce 1—,
PS Form 3811, February 2004 DomesUc Return Receipt 102e95-024A-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this cans to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
L orf% 'ye#-n
VW1 ij'14'a ,Dr
A. Sign turd F
X
B. 'Aeceiveh by (Printed Name)
D. Is delivery address different from item 1?
If YES, enter delivery address below:

66-19/530 NC
LIED MARINE CONTRACTORS, LLC 08-03 702
910-367-2159 - E%
92 HAROLD CT.
HAMPSTEAD, NC 28443
11'004069li' 1:0 5 3000 1,961: 000684
AUTHORIZED SIGNATURE
74373811'
DOLLARS