13151_SIMMONS, DOUGLAS_19940906

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CAMA AND DREDGE AND FILL
GENERAL
PERMIT�o/ 'Ir
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
Applicant Name
e �"�° T f�' s , / -kr' -X-1. - % !, Phone Number ` /0 ri c1 V c� h C1 I
Address (n S�
City. rG'J•r; 7t;' ,_-"� State %J"' zip 7 %
Project Location (County, State Road, Water Body, etc.) C'*^ �`� '7
i Yr ! C. ✓ f � �
Type of Project Activity
PROJECT DESCRIPTION SKETCH � 4 S
Pier (dock) length
Groin length
number
Bulkhead length
*�O A
,a.. distance offshore
-1
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
I
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.
Theapplicant certifies by signing this permit that 1) this pro -
is consistent with the local land use plan and all local
fiances, and 2) a written statement has been obtained from
O
adjacent riparian landowners certifying that they have no
objections to the proposed work.
■NEMt���
�NONE
IMM■MME MEN0
AMIN M lMWMM-
�MIN.
t�
applicant's signature
i
C' permit officer's signature
issuing date
attachments�J7 ! �'
expiration date
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fee

DOUGLAS D. SIMMONS
LIC. 5142798 PH, 924-5503
2626 SPEAS RD.
WINSTON-SALEM, NC 27106
PAY TO THE
ORDER OF _
374
66-7779/2531
l9
—� $ 50 - d0
/� DOLLARS
MEMBERS
CREDIT UNION
585 Waughtown Street �
,,��%% Winston-Salem, NC 27707 ?
MEMOP hL �O/Ocv_
1:253 L?77931: wCG 50048 2 Lill
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
I(YiMdX)S 's property located at
(N .e of Property Owner)
0 rz
�--�
(Lot, Block, Road, a c.) --boo/1e
on �A i �-S Cr iOUC.&n 4T C16 - N.C.
twat , : ,,o ) own 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
w 5lI-)nzyldry 1c,
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tu
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C.o 4 ti �- Ce 4U
Print or Type Name
? y-7''Z�'-fail
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify -t I own property adjacent to
' s property located at
( ame of Propert e1r) ) ,,
U c,B4-loc�k�, Road, etc. )
5 ti
(Wd -body) Town and/or County)
He has dec;_ribed to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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W LUU UU& kA-p �J+b
KW ivct,' 111x6f? -
-T -b P n2 'J -i" k
Sig
rint ok Type Name
77?111- O � o l
Telephone Number -'

MONITORING &COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
J)
PERMITTEE'S NAME: 41 v f a 5 l ti,. �,. C9_t+ PERMIT#
LOCATION: C u 7 / .p.,
p f
C 0l�n
y lg a i cva s
/q� FIELD REP. C, e• �i l�
PHONE: 7/0' f vl ;- S S�d ? DATE REPORTEDLY COMPLETE: 10 `r- 11
1) Do the measured dimensions of the development differ from those indicated in the permit and workplat?
YES/ 1 % circle one].
COMMENT: t 440'7 Z/ffl' S
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized
all disturbed areas? O [circle one]
3)
COMMENT:
action needed? YES/IW[circle one].
COMMENT: /U7 6 L11-0 c i
: Is further investigation or enforcement

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