Simpkins, Ann

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GE & FILLtff
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PERMIT
W?N
Previous permit #
ew'` ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources ,Tj ,-; j �' i��•;
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC `, ; t'* •'
'' .,-
p Rues attached.
Applicant'Name ), , r,' I f r`�
Project Location: County.-
il
Address, ? r
Street Address/ State Road/ Lot #() s r° , •>,:-h
"-
9
City. `► State .:1. ZIP ,!
Phone # ( ) d ,' ^ i;]7- � E-Mail
Subdivi;ion
Authorized Agent /'� ` ` , ,'
f°i ,/;`' ` -6 r �� 1
I
City z ie k 1 iC1 ZIP
❑ Cw AOTA ❑ ES ❑ PTS 1
Phone # ( ) '� River Basin ! ��1I i
,�
u 4"A
Affected --
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ WA
Adj. Wtr. Body '� nat
_i
an unkn
El PWS:
ORW /� no} PNA /a4'no
Closest Maj. Win Body
yes yes
Type of Project/ Activity�,-
111111111INNIMME ME No
Fixed Platform(s) 1111MMINIMME 0
ME .4110010M
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
ayg distance offshore—
MENEM I
Basin, channel
cubic yards
Boat ramp
Boathouso Boatlift
Beach Bulldozing
Other r•
Shoreline Length
SAV: not sure yes (no
Moratorium: n/a yes 'no,.:`
Photos: yes 'ono
Waiver Attached: es'j no
A building permit may be required by:
( Note Local Planning jurisdiction
Notes/ Special Conditions
r)c?
! -: ! 1 /-''z�)v�✓
Ne
(Scale:
See note on back regarding River Basin rules.
rAppliSa�nt Printed Name
Permit Officer's Printed Nam 1^ `
Signure Please read compliance statement on back of permit
Signatureel
A."
ApplicetionFee(s)
Check#
IssumgDate
xpiratlonDate

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 El Other:
F 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 complywith these buffer rules.
Division of Coastal Management Offices
,Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
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)
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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

R
Name of Property Owner Applying for Permit: �it �„� S rn mIL►Ns
Mailing address: ' snv--m L ov e-
Le-*i"ko-, S.c. 2610'72
Telephone Number:
I certify that I have authorized l) , O 13 ,e_ICaT 'DeVtsj KS (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of _ F I a4-L , r'., bo&V, fn o--M- L� F�-
at my property located at 1 g 4 4�;,q1 +cr Po44i► '?-. ,
This certification is valid through (date).
(Property Owner Information)
Sq6nature
A n,•i - , n-k ek-, � i
Print or Type Name
owns^
Title, co, owner or trustee for property
RECEIVED
Is
Date JUL 31 1015
07w-
Telephone Number
Email Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to N N S i ►^n R k) P,-j 5 's
(Narrve of P operty Owner)
on CALL , in
(Waterbody)
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
'A5 I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development mast fill in description below or attach a site drawing)
-0 0
�--4) -0 i uS
m o'er E 144 �p
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, you must initial the appropriate blank below.)
As I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signat re ` -
.�-' ' s
Print or Tye Name
Mang Add ss
cx i a 4 . ,SG 2 �1'D 7 7
City/Stag
Z,33/ _
Telephone Number
7/20%5` -
Date
0yp Na
wt/
Telephoe N mbjer
J
Date
er Information)
CLs11015
(Revised 611812012)

h ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to 19 ).j N '�'l to 014 1'r''r 's
(Name of Property Owner)
w;.prr�perty 1o�Le�l .fit t'A 1-#..c,� ; `j�o cL ►�. ...... .._. -
vin
on �9- w ve �o L _ , in �� S , N.C.
(Waterbody) (City/Town and/or County)
The applicant has 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)
ivt, L '�fi
Efio,44,e r - —1 1*
I 4 n ^FOIL k CC-e!s'
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, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
S i ature
Mto 4-) ,;, r rn p (c- 1a-5
Print r Type Name
Mailing Address
C+�IIt54oIli 5.<, ?9©)2
City/State/Zip
Telephone Number
Date
-
Sigr�cture
0- "y-Jw r,nnlLilyT
Print or Type Name
11q 1,a4woor� L�r,.c_
Mailing Address
Lcr1 Aj t; a
Cit /State/Zip
V � SAS �� 3 RECEIVED
Telephone Number
"-I' e2 L S JUL 31 2015
Date
(Revised 611812012)

u�2'
MP
K-, N5 sown property adjacent to(perty Owner) x
.�w
- ,(A Fd ess,. Lot, -1:111
in
(iNaterbotly) (CitylTown andlor County)
,ant has described to me, as shown below, the development proposed at the above
I have no objection to this proposai.
I have objections to this proposal.
®ESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT a s to drawing)
(Individual proposing development must fill in descrrptaon below oattach
s
L L
® Q
}2.os P--� ae'� br
vvAIVER SECTION
IY.understand.that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
area of riparian access unless waived by me. (if you
back a `minimum distance of 15' from my p
tir�shaa;waive the setback, you ►gust initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15, setback requirement.
(t? bperty Owner Information)
(Adjacent Property weer information)
V. Signature '
Sagrtature,
�zN rnD S
Pi too Ty Name
Print or Type Name
Mailing Address ,
M ►lrng A9ddress ^ _ 'Z O�
C City/State'p
it /,St�
Telephone Number ;Z•�r
Date r
Date
` p P
s