80248D - Grady

0._ CAMA / DREDGE & FILL No 80248 A B C CjGENERAL PERMIT Previous permit# 7j1
)IC JNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality /!
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7/! • //00 ^ /2-d0
/ ❑Ryles attated.
Applicant Name f 'N C/- 6- w Project Location: County ON r/0 6./
Address / Co (-0(-, i4 7,74:1-
' Street Address/State Road/L #(s)
City �U� o'78 State —Z1P 3c' 4 I% 1f 5: •
Phone# l'LYy"6`/�I / E_ l Subdivision
Authorized Agent r~ t^^�� City "/�F ZIP Z� / Y
A S PTS Phone# River Basin /N• 0 '
Affected ❑cww ty�Pr ❑ ( �----
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body 1 4-4-^ a r o ( SG-. Mel /unkn)
❑ PWS: /
Closest Maj.Wtr. Body %i L/fr''* fp Sw ti
ORW: yes / no PNA yes / no) //
•
Type of Project/ActivityYP 1 � •ate�G-G¢.� !!�� Ai�f.�l� y� � �i.C�f�l/ Qdd�[ � 6:-ef / if?
(Saab: / / zo
Pier(dock)length ,
Fixed Platform(s),/4 , X 7 u i
Floating Platform(s), rj x /G
Finger pier(s) 3 f'" 2 r� i p i.-- '—_ ' I
Groin lengtht.
number __...---._._ -. __..�.._..._ �_._....._..._.._..----- ._--_. _ ._..._.._..+_
BulkheadLRiprap length-</ d� p �f� ,�1z r/_ {��
I
avg distance offshore / . _44- 5 N` iwt•�[/�N,r
max distance offshore / '
Basin,channel �(,
1 11,
Al .
cubic ds r
Boat ramp W. , hi
�I ji - 1T ,
—}- —.. �.� _........ —.._ 14� �1 1 i I
i
L
Beach Bulldozing ,\ i'' }
Other
Shoreline Length �7 i
/..rt 1 ;
SAV: not sure yes _'-- i , I
Moratorium: n/a yes K '
—1_
Photos: yes ,Yfie
I
Waiver Attached: yes , I f
A building permit may be required by: 5:/ o ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) /
Notes/Special Conditions
y6L �`�� T / t
or Applicant Printed Name PerrnitOfficer's Printed Name
'VF
ziy
Si re '"*Please read compliance statement on back of permit.** Signa
Ze,
X-) ( --,-,y44-,-„)
Application Fee(s) Check Issuing Date Expiration Date

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 I)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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648I) or the
Wilmington Regional Office(910-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City_Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 9I0-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

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❑,VOID ❑ CORRECTED
PAYER'S name,street address,city or town;state dr province,country,ZIP 1 Rents OMB No.1545-0115
or foreign postal code,and telephone no.
$ 2©20 Miscellaneous
• 2 Royalties Income
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld
$ $ Copy 1
PAYER'S TIN _ RECIPIENT'S TIN 5 Fishing boat proceeds 6 Medical and health care payments For State Tax
Department
• $ $
RECIPIENT'S name 7 Payer made direct sales of 8 Substitute payments in lieu of
$5,000 or more of consumer dividends or interest
products to a buyer
(recipient)for resale ❑ $
Street address(including apt.no.) 9 Crop insurance proceeds 10 Gross proceeds paid to an •
attorney
•
$ $
City or town,state or province,country,and ZIP or foreign postal code 11 12 Section 409A deferrals
$
Account number(see instructions) FATCA filing 13 Excess golden parachute 14 Nonqualified deferred
requirement payments compensation -
+ 15'State tax withheld 16 State/Payer's state no. 17 State income
i
x .. '€ `"3,r ,x*•
r sy $ $
no-
Form 1099-MISC www.irs.gov/Form1099MISC Department of the Treasury-Internal Revenue Service
",ECEIVED
APR O'5' 02,1.
DCM WILMINGTON, NC .

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/ver, ,LyP\
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RECEIVED
APR 0 5 2021
NCDEO
WILMINGTON RO

3/8/2021 4thstreetwaivers-1.jpg
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to / till 6( L.. 67a- is
'loll
u� (Name of Pr rty Owner).
property located at f o ll / ,Siff r�wi C„L� G 2 gay
(Address, Lot, Block, Road, c.)
on CAA} , in 50/ G'4 O�.Slow Co , N.C.
(Waterbody) (City/Town and/or Count
The applicant has described to me, as shown below, the development proposed at the above
locati6n.
t I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
d ?rth t40440:100*0 1.401.�n%scr►eki- OPOI %at-4ltaei ft rliawr )
--o c.1c 47:1o1%r S
•
•
•
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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 I do not wish to waive the 15'setback requirement.
(Property Owner Informatio ) djacent Propert wner information)
Slog]F . atu
/
Print or Vype Name Print or Type Name
?z u c Hwy/ 15
Mailrng_Ad Tess aiingAddress. I
City/State/Zip City/StateIZp
q(7- 3qf/-Gy fy 4/, `�%imiy—,.h 4,J C hi i1cnar f'. try�rt}L t ek . r 4-
Telephone Number/email address 01,... /Lv Telephone Number/email address
7-P- �f 24 -7 j .
Date Da
(Revised Aug.2014)
`Valid for one calendar year after signature"
https://mail.google.com/mail/u/2/#inbox?projector=1 ill

3/29/2021 Adobe Sign,an Adobe Document Cloud Solution
11Mtrmeirakeho4pe Lltr�ml
ADJACENT RIPARIAN PRQ PERT
V 4,OWNER TATF.►�IgIT
I flereuy ceI that 109ve property adjacent la / 4 P6f��p�C� wee 's
(Address,Lot~Qlock,.Re�d' j-
on.wt 1 .In ur �t . . wa. Ca✓11 N C.
{IA►aterbodyl ( rty/fawn endlor Co rtil
The applicant::two dose lbe i to me,aS shown'below,the devetOpmed proposed at the above
-t/ I have rib of tc lion:to this. aposat.
I have otiect ons to this proposal
OESCRIFTIOR ANDIOR DRAWING OF PR9POSED DEVELOPIiAENT
�Indltddvakprgpoibi�dove/opment must link In descdp1Ion bclaw•ar altacli's silo
drawing)
Dock repairs-see drawing
WAIVER SECTION
I understand that a pier.dock.mooring prltngs.boot ramp,bretikwe(er,boathouse.lift,or groin
must be set bock a rmninnrm distance of 15'from, my araa of riparian occess unless waived by
nv.(If you wish to waive the satbock„you must nipet the opproprlate blank below.}.
�I:da wish re waive tho15'setback requlremenl
�/ I do net with to Waive the.1 fi'setback requtrertrerrt. .
(Property Owner trrformatiap) (Ad t Property ormatio
Si narrboe. SY
�r« ..Name Na
oirstikeiziP
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rekohonn Numbar l*snag epler„4,,) •
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/Re•vised Aug.25l4j
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3/8/2021 4thstreetwaivers.jpg
AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: / ►1i 1 L.
Mailing Address: (-� �C� Ice ! pexy
60l15-b, „
Phone Number: gi .3 ?q- 6Y 94' et- %/j
Email Address: '/ ,574 Ve5r4/1 Cr7 (21Ai4// . 071/
I certify.that I have authorized 13Q,8
Agent/Contractor
To act on my behalf, for the purpose of applying for and obtaining all CAMA permits
Necessary for the following proposed development:
at my property located at 11017 qt� k-cV 5M'1 j G gyy ,
in alilai County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter ,
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Si
Amly 6/4
Print or Typ erne
Title
3 1 i Z /
Date.
This certification is valid through 1 /
hops://mail.google.com/mail/u/2/#inbox?projector=1 1/1

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Check
Date Received Dah Depositrd Chock From(Name) Name of Permit Holder Vendor Check number amount Permit Number/Commenh Receipt Or Refund/Reallocated
Corumnl Column2 Cotomn3 Column/ Columns Column6 Column? Cokunn8 Column9
4/8/2021.. Backwater Marine of NC LLC Wade Rozier BB8T _ _ 1275 $ 200.00 GP 1180288D BB rot.12992 _
4/8/2021 B and 8 Marne Construction Mindy Grady Wells Fargo �_ 1731 $ 800.00 GP 880248D —$200 credit(GP is$600) JD rd.13470
__4/8/2021 Richard Penny Construction,LLC KeIN Nester INAW Federal CU _ 1568 $ 200.00 GP 080205D 'KE rct_13426
4/8/2021. —TV—CC.Inc. Misty Easton IBBUT t 82721 S 200.00 LOP motel I48 rd.12993