16485_SIMMONS, FRED_19961003

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
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as authorized by the State of North Carolina =>
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental -concern pursuant to 15A NCAC
{ (H �; - 76 % 7
Applicant Name `"' ..,_/1,fn0'4r Phone Numbed) 72Y-0,5-19
Address
City State /VC zip�U S9!Z
Project Location (County, State Road, Water Body, etc.)'//>v
Type of Project Activity
PROJECT DESCRIPTION I SKETCH
Pier (dock) length
Groin length
number
Bulkhead length 'rz'
r
max. distance offshore -L_
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
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,
imprisonment or civil action; and may cause the permit to be-
come 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) this pro-
ject is consistent with the local land use plan and all local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
U
(SCALE
permit officer's signature
issuing date expiration date
attachments , %/ 4 �dr,
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee 0 � �LNr If� ���

FREDERICK oi»s
S ESIMMONS4183
HIS 0TIMBER
578 i ss-3oi531
1204 TIMBER TRAIL
EMERALD ISLE, NC 28594
FAYTOTIiE
ORDER OF
■ii7a7TCITIL.Elr�7V,2Z1Al Vv i �L P,64�il DOLLARS
FlrsbCllissns Bonk & Imsl Company
i��tB�'�IM ll .
FOR�MzlUtto
1:0531003001:227764158011' 4L83

FROM : NORTHWESTERN MUTUAL LIFE PHONE NO. : 9102725528 Sep. 24 199G 10:03AM P2
g-2a—�996 :03pti' FRCM JIMENEZ 010 ZC-4 50GS
ADjACEN-T RIPARIAN ;PROPERTY OWNER STAITIV ENT
(FOR A PIER'UNCOVERED BOAT LrFli�+
I hereby certify that I own property adjacent to AD iMA dlyV s
(Name of Property Ovm,-r)
property lomted at 4 0 7
d
r� /� (Lai, Block, )(toad, etc.) * 9zr
on {�O'`. r d%yI,.L m (ql �(t N.C.
(Waterbody} (Town andlor Countyl
He has described to me, as shown below, t,)e development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/uncovered boat lift
must be sec back a minimum distance of fifteett feet (15') from my area of riparian access unless
waived by me.
0
I do 1! wish to waive the setback requirernty.
I d2 wish to waive that setback requirement.
DESCRIPTION ANWOR DRAWDiG OF PROPOSED DEVELOPMENT.
(To be fiUed in by individual proposing develapmens)
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i�i�i..riaw� • • •.�a��ri\\�
Signa re
Print or Type ratite
Telephone Nu
m q
Date:

I
0-
6
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to f' R SIM AN d W
(Name of Property Owner)
property located at L'b
(I,ot, Block, Road, etc.) �SC
on SouAID in E AA F. R Jq 1,V S Ci G , N.C.
aterbody) (Town and/or County
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/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
_ (To be ,failed in by individual proposing development)
' J
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Signature
r E LH /,/ <1�'
Print or Type Name
Telephone Number
Date: 2/2