80171D - Grisales

to,,±.=CAMA / DREDGE & FILL No 80171 A B C
GENERAL PERMIT Previous permit# \
> New . Modification ❑Complete Reissue -Partial Reissue Date previous permit issued I(`
As authorized by the State of North Carolina, Department of Environmental Quality II , !'/, //�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC vv
-�}- r ❑ les attached.
Applicant Name -.AU A (T 1 / c C Project Location: County Civ'`i(
Address &4 CO ✓I -qv// - L4 1A g1d. . Street Address/State Road/L t/#s)
City C1 11.1k AAA, State VA-ZIP Z 9 S3/ 36 i''� `�
L �
Phone# (t4 30 7 s 5 S`f 3 _Mai:, y7,20: c-, net A,',(��,yi Subdivision Authorized Agent .O City 'jv/...4-- Crbt ZIP 7K4"
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Affected '❑cw I�rIEW Ci,PTA MIS 0 PTS Phone # ( T-- River Basin 'v '
s ❑OEA TO HHF ❑IN El USA ON/A
AEC : Adj. Wtr. Body ��/N0 4❑ PWS: I c• (nat /unkn)
ORW: yes / no PNA yes Closest Maj.Wtr. Body 5. ✓ r s-,a r
Type of Project/Activity flif 1G.--t-C/ CIO Lk {�, • i'llq. ki kh- ` .0 .
(Scale: / =l 0 )
Pier(dock)length r /
I. l 1 l i
Fixed Platform(s) 17 x Z 1 -_
Floating Platform(s) t
Finger pier(s) ' © r/ /Y /
Groin length 2 y
�_
number .., _._... ._..._ j--+
Bulkhea prap length f�—S — -�� iq h l �,-y — f = •
" - avg distance offshore I I 1 'r _ r'� `��
/ • i
max distance offshore ! / ���� +yL = f
Basin,channel\\NN
I i - l6ti
t , /'�
4 , 1&,,zeffitt kfilatz+A-1
cubic yards
I
Boat ramp , \ I e �
Boathous /Z X (7i ..— _._ _—. —
Beach Bulldo . g I
r 7 �/1/Other , , ' liu.mr*.__I ! 1 .1 I —
_/ 17 t j odd Wit '
Shoreline Length 1 i—? c 7 Pit I I l'
SAV: not sure yes iT ,3 04fT. * -.._.._.._, _.. -
Moratorium: n/a yes o , i
Photos: yes o y ' 1 I !
Waiver Attached: irp I , _
A building permit may be required by: 5 t_.✓!� I I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
—
: 677.i r/ (t/&- ---__
Agent or Appli n_nt_ed Name rmitOffice 's Printed Name
Signa re **Please read compliance statement on back of permit" ig
l ' i 1,461
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 (252-946-6481) 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 910-796-7215
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
e ',hereby certify that I own property adjacent to 76e ve R. If/ 4 A ic 5/ace c 's
` (Nance of Property Owner)
property located at . 36 LIP. � R + S 4-
��� (Address, Lot, Block, Road, etc.)
on , in S LJ R 1--' C.. (4-v. , N.C.
(Waterbody) . (City/Town and/or County)
The.appli nt has described to me, as shown below, the development proposed at the above location.
1 OD I have no objection to this proposal-.
•
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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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 7_,
the setback, you must initial the appropriate blank below.)
41 do wish to waive.the 15' setback requirement. . . c
aA -
I do not wish to waive the 15' setback requirement. �
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(Property Owner Information) (Adjacent Pro w ation)
Signature c Sign re 5)-
5S-aveg_ky cRcsA-(eS at(fai a,1i 0Print or Type Name Print or Type Name
sO Li ? 3 ad S ( ? C)sa ?"et c4-
Mailind�Ad�drs �y y�, Mailin ddre
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City/State/Zip City/State
y34-7�s--s^9 3� ty p �/� - ?y9 - s"3o 9
Telephone Number Telephone Number
V-/t"-ao� / yy/1" 2(
Date Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
d hereby certify that I own property adjacent to e u e g(t/ C k't5ig-t1 's
roe - (Narhe of Property Owner) •
P P rty located at 0 �( F 3 rz l S-t-
on C A N c_ (Address, Lot, Block Road,etc.)
, in Su&# C' i-t-yy , N.C. `Z�'t/c/4r-
(Waterbody) (CiitylToim and/or County) ..
The.appli as described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal: -
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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Ala` s c 4[� " r ��`�'
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H —T �" 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, u must initial the appropriate blank below.) •
04. I do wish to waive the 15'setback requirement.
-- ---- _ __--I-do-notwish-towaive4.ha--5'.sethack-requirefrent.: -. --- - - __ -- --
(Property Owner Information) (Adjacent Property Owner Information)
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Print or Type Name Print or Type Name I y
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Mailin Add ss Mailing Address
'`' (2 /v . /t/C V-ys' m+ d lave Ate . .
City/State/Zip City/State/Zip
,/3q- 7ss 's l 3,,2 a6.365-
Telephone Number Telephone Number.
Date Date i1'/8-Zo A.l
(Revised 6/18/2012)

Check •
Date Received Date Deposited Chock From(Name) Name of Permit Holder Vendor Check number amount Permit Number/Comments Receipt or Refund/Reallocated
Column! Column2 Column3 Column,' Columns Column"' Column? Column"' Column9 _
5/18/2021 Bevery A Grisales same American National 1056 $ 600.00 GP#80171 D JD rct.14128
5/18/2021 Lighthouse Marine Construction William Ussell Coastal Bank and Trust 6758 $ 200.00 GP#80169D JD rct.14130
5/18/2021 Southern NC Marine LLC Legacy BP LLC First Bank 1428 $ 200.00 GP#79916D JD rct.14132
5/18/2021 Davey Resource Group Inc. Bert Lea Jr./Dorothy Medlin United Bank 2253 $ 800.00 GP#79922D JD rct.14133
1