53980D - Gregory

❑CAMA/ ❑DREDGE & FILL F�
GENERAL PERMIT Previous permit#
❑Nev4 ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 3 . j i' J £ i 1�(•D
[Mules attached.
•nt Name v Et.) 65 (LEt. R-1 Project Location: County 0 ps+- ,.-—
:s �' Car. T r'_ \.,A?c,.*,‘,A,..L..t' ,1 e Street Address/State Road/Lot#(s)
L l..t.I -) i-�c-) State rJ L ZIP Z�5 -1 t z' 5 -) '
L
#( 11 . ) S9S. LI ' o`fax#( ) Subdivision
•ized Agent City v+n-F (_L`; / ZIP t2.._.. '
.d ❑CW f JEW p PTA ES ❑ ,
PTS Phone# ( ) River Basin Vv�}
❑OEA ❑HHF ❑IH E UBA ❑N/A L LP.J°``
1: Adj.Wtr. Body U tY-N c) �.. r3� (nat
❑PWS: ❑FC:
yes �_� PNA yes i no Crit.Hab. yes / no Closest Maj.Wtr. Body '^ `� S=�'."J`�
of Project/Activity 1 N)�c Al.,- c� Li N f Att & C i 3
LI' ..,t.,- 'A I.t< la IJ 1..4 X I J ? ‘ OCc G 4-tom--- (Scale:\t' =
dock)length
rm(s) 1 Jul 2 — I I ,
•pier(s)
length I I ! 1
lumber I J f
aad/Riprap length S- (LI 1
I i l
Ivg distance offshore '��' �T+_
nax distance offshore j\.J
channel I -
:ubic yards •
amp
Ouse/Boatlift /0 /LI I I
I.,><
Bulldozing
i.-L.`, /`-, 5 a 1. .nt.N L Lit
1- f
ine Length cS 41*
not sure yes 6 P _ I I -j
lgs: not sure yes
1: / yes o . I
r Attached: yes _ _ _ -
Jing permit may be required by: C ^.2.( L-tT-` See note on back regarding River Basin

I
e �
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F.Easley,Governor Charles S.Jones,Director William G.Ross Jr.,Secretary
Authorized Agent Consent Agreement
.)nrr)oa t CL; ST ,:ri't bf.4 is hereby authorized to act on my behalf
(Printed Name of Agent)
in order to obtain any CAMA permit(s)required for the property listed below. The authorization is limited to the
specific activities described in the attached sketch.
LOCATION OF PROJECT:
7),yA 71 ST
`Qi CA-cm) t h1 C
aSS'i5 4i
PROPERTY OWNER MAILING ADDRESS:
6E3 1 An Arn c,pr-t-NL:tr1i S I:
I 1 t1 1+1G>i-A, N C
c_75-`y h PHONE NO. Ok it)- -593- `thf;la
AUTHORIZED AGENT MAILING ADDRESS:
1'i5 V126iwl1A L$
6Nle"An r'F'c e9, N('
,ifs Ll Cr)
PHONE NO. 9 in -337- 3y7S
t
Signature of Property Owner J_*C2
Signature of Authorized Agent a ;
Date ,// iG 0 7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ctuq totarc,c, y? 's
(Name of Property Owner)
property located at ,nSA 7Tt4 ST ,
(Lot,Block,Road,etc.)
on ( 20,N ry ,in S o12F C vT.? ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone#:Aitarliat_-±XX, Mailing Address: 4,R 1 tlAM IF aPr1-i t I P
j I LLI 14circla, tic. 2754 L
He has described to me,as shown below,the development 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.)
iI do not wish to waive
J I Is wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying (Riparian Property er Inbprm ' n)
for Permit) ,..4, e
4,s1 I t»Aryl,E. Oft-rtoRr H l'D ✓ 5 ,3-
Mailing Address igna
t ►�u6- a, t�.c. a.7cq, ✓ k.22;. " 13. gf1 I-_
City/State/Zip Print or Type Name
CI ld-993"MSC. I 1/P— ff 7 G ‘ I
T�ele hono. %e Number� . JJ Telephone Number
X (/ , ,.1i If�19'fki i/J ..... 027_ 9) 47

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7971
Bank of America
RI CONSTRUCTION ACH FUT 053000196
145 VIRGINIA LANE
4DS FERRY,NC 28460 66-19-530
[phone]
3NOv 09
00
$ tiod
),Prn RAH) °oh
DOLLARS
AUTHORIZE SIGNATURE
� C tarN)
D0 7 9 7 V' 1:0 5 3000 L 9 61: 0006505 2 9 901i'

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2, and 3.Also complete A. Si. ature
item 4 if Restricted Delivery is desired. hn , nt
• Print your name and address on the reverse 1At4 ❑Addressi
so that we can return the card to you. B.Received by(Printed Name) C. Date of Delive
• Attach this card to the back of the mailpiece,
or on the front if space permits. l/�"�37~�
D. Is delivery address different from item 1? ❑��Ye
1. Article Addressed to: If YES,enter delivery address below: 0--No
.��m E-5 51'
1-3 PA.S-P1 �r a s Li c 3. Seryjee Type
Certified Mail El Express Mail
❑ Registered ❑ Return Receipt for Merchandi:
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery?(Extra Fee) ❑ Yes
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-15