39643_GRAY, MICHAEL_20040809

E CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
ENew CModification ❑Complete Reissue ❑Partial Reissue
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
Applicant Name
Address 9 ( 1 >f'( /1 L
City_ r t c,". is State ZIP
Phone # ( ; SI ) 997 ZZtf f Fax # ( )
Authorized Agent r f J
Affected ❑ CW © EW )A PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / .no Crit. Hab. yes / no
I 4 01P 9
Previous permit #
Date previous permit issued
'a
Rules attached.
Project Location: County r
Street Address/ State Road/ Lot #(s)
er.c, i_ ,•�•c
Subdivision /f t
City_ ZIP
Phone # ( ) River Basin WA
Adj. Wtr. Body ' . - �ir k fnat'Jman /unkn)
Closest Maj. Wtr. Body lj r F k �t �rv/ J, • ' //. P_
Type of Project/ Activity r J i 0 ^e
r t
i;l�I rw {�*t� try c f( oy. j s� f �t•t c( {�uc.: (Scale:
Pier (dock) length 4
Platform(s) U f✓ t `j ._"� f F u F ✓` r�
Finger pier(s)
4
Groin length -»
number
Bulkhead/ Riprap length t
{
avg distance offshore
max distance offshore
Basin, channel -_. - - -- - - - 4� tt
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
- � .r- . ter•
i
i
Shoreline Length !'. i (� J
SAM not sure yes ho --- ----- — - -- — i
Sandbags: not sure yes
Moratorium: n/a yes no
Photos: yes 0 r
1 , k !
,� im
Waiver Attached: yes of --f/-- - - ]---- _ .
A building permit may be required by: (p , '((+ f ! / _ See note on back regarding River Basin rules.
r
Notes/ Special Conditions) /' " t(f t of r)0 1 ro • //! frr 1 U
lit., �lpy�ri �, �' ��• lt(I[ h%. �i,i1 h G / 1. .�i �. 1(. r� !l U;� 6rry l- i
Agent or Applicant Printed Name " r
Signature PI a read compliance statement on back of permit
Application Fee(s) Check #
4"t,4,
Permit Officer's Signature
r `1 /'g
Issuing Date Expiration Date
(,6,fF�t' r t31E1�f1
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:
Tar - Pamlico River Basin Buffer Rules Other:
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/OS/01

. ....... _..............
__._. _....
I�ikTEDSTdTES PO`7TAL MONEY ORDER is aoo
STdL SERVICE® 000
SERIAL NUMBER YEAR, MONTH, DAY POST OFFICE U S. DOLLARS AND CENTS
073 5 8 5 2 50 6 2 2004-OB-09 '85570
ONE HUNDRED DOLLARS & 00 ##*#***
AMOUNT
NEGOTIABLE ONLY IN THE U.S. AND POSSESSIONS
PAY TO
SEE REVERSE WARNING
ADDRESS
FROM �)
CLERK
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ADDR j r�
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OR USED FOR �/�7✓ / /�C I%X ./� //
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I t0�r800 21: 073583 2506311'

ADJACENT RIPARIAN PRGIPER-I-Y OWNER STATEMENT
(FOR A P!£.R1,1I00RItYG PILINGSIBOATLIf-TIBOATHOt'S£)�Ij ;{o�? , f a w
I 'hereby certify that I own property adjacent to��-� s
(tinme of Propertk ON%ner)
r
property located at zL
(Lot, Bloch, Road, etc.)
on n a
(Waterbody) (7 %,n and/or Count})
He has described to me, as sho%,n below, the development he is proposing at that location,
and, I have no objections to his proposal. I Undersnund that a pier/mooring pilings boatliWboathcuse
trust be set back a minimum distance of fifteen feet (15') fron, my area of ripari.irt.access tEnacss-�
waived by me.
I slo not Wtsh to waivt the setback requirement i
1 9 v. ish to a aive that setback requirement. A'_I;; 0 9 2004
- �€
DESCRIPTION• AN OR DRANVI�NG OF PROPOSED DE�'110,N ENT:
(To be filled in 0111di►•idurtl proposilq development)
Telephone h- —�

ADJACENT RIP�RIA1 PROPERTY OWNF—R STATEMENT
(FORA .PIE'Rl1TOORIiYG FILfiVGSIBOATLIF2rlBOA/THOt%SE)7� .YV -F), / /
I hereby certify that I own property adjacent to �=�X. �i�� f S
I
property located at
(Name of Property ON%ner)
(Lot, Block, Road, etc.)
on�%��2Kf�' lY n --.C.
(Waterbody) (T vn and/or Count.v)
He has described to nie, 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 boatli"ciathouse
mast be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. J
I do not wish to waive the setback requirement -
I do wish to waive that setback requirement.
A' 4 9 '? Q i:i 4
------------------------------------------------------------------------ ------
DESCRIPTION' AND/OR DR.AWING OF PROPOSED DEVELOPMENT:
(To be filled in bt' individual proposing development)
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Ra o iC S
Print or Type Fame
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Telephone 1\'t mt b re
IDate: