Simpkins, Ann (2)

1l:CAMA�!DREDGE &PILL
N ' 55^4
GENERAL PERMIT
Previous permit # a
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New COModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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As authorized by the State of North Carolina, Department of Environment and Natural Resources{ r ,y,
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
3
' Applicant Dame i !' t r ') �y {
Rftles attach.
Project Location: County
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Address' i ; ? i"' x: l ;;'
Street Address/ State Road/ Lot #(s)
City w-� t7C �'�t rf_� ' State . ZIP,
Phone # (iPT) _'^" { E Mail
Subdivision
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Authorized agent i �' i i f `i t i (`'
City 11
r `t ` ' r (" ZIP :
❑ CW • LY'EVI/ ,< .A-P-rA <,,.©ES a PTs _,
Phone # ( ).. '� River Basin
Affected ElOEA ❑ HHF ❑ IH ElUBA ❑ N/A
AEC(s):
s
Adj. Wtr. Body s'. I''
r `1
nat and unkn
❑ PWS:
ORW yes /�o1 PNA yes (noi
Closest Maj. Wtr. Body t ;
Type of Project/ Activity+''
` c � (Scale:. 1
w
Pier dock I #. 1►
Fixed
Float
Fing
Groff
�ulk
Basil
Boa,
Boat
Beac
Othr
Shor
SAv
Mon
Phoi
Wain
!n Platform(s)
n length
nurnber
ayg distance offshore
max distance offshore
cubic yards
RON
ramp
MEN
IN
OMEMM
Rmom
am
MEMO
ON
00
A building permit may be required by:
( Note Local Planning Jurisdiction) 1 �.
Notes/ Special Conditions1.
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See note on back regarding River Basin rules.
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PermitOfricer's Printed Name
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Signature
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Issuing D to 'E
t
i Date
a. Via,
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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
0 Neuse River Basin Buffer Rules
Other:
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 howto 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

Name of Property Owner Applying for Permit: P) U W WS,
Mailing address:
_�'C�l ►�S $o M S . G . 2� 07 Z.
Telephone Number:
I certify that I have authorized �M �p t"�v�1C�� ►'7rdt-��Mc (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of _��, 1 cue►.,,, �,.,T ..Au. s 1
'Bo 44-
at my property located at I nn is 1 IF Co �
This certification is valid through (date),
(Property Owner Information)
S g ature
Y% h � i rn :'rvs
Print or Type Name
Owe-e./,-
Title, co, owner or trustee for property
Date
-10 '4 S'1S (.,331
Telephone Number
Email Address
RECEIVED
JUL 31 2015
�+

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that l own property adjacent to N 1,4 I m Ki tit S s
(Name of P operty Owner)
(Address, Lot, Bl , Road, etc.) ._
on r,. in P 14-s , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca ' n.
1 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)
lzo:3L-P— -� 44-6-
Vz P I,p CK rn-E� P 1 ( >,-.", a( )
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)
M
Signature "
JPto'0
Ty N,55 IN0-�)p L'a X,I,F
M ding Address
City/State2ip
7Du- .S? -- .3L
Telephone Number
Ii - A �
Date
(Adjacent Property wrier Information)
Signature _
RECEIVED
Print or Type Name
a iL 31 2015
Mailing 22- AessA ,mil /',
elepnorre ivumaerl
Date 7X9OP.
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to 9 ru N' -5 t ^"o-- I its is
(Name of Property Owner)
1,151 _�.M..149
(Address, Lot Block, Road, etc.)
on 4fA �+�+� L in � IC 5 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
A S I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AMID/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
0
A DO Lie--+
��Sv ��cGzS
'fJm c1L
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.)
PY?- 1 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)
Si�Q'(72ature'e�
I-li-1u
Print or T We Name
1 � 41 2n L09
Mailing Address
k-rte- 2R0-12
City/State/Zip
�-16q- S -)S
Telephone Number
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�p-
SlOnature
Pr, r,'3,,r.P k, A,rs
Print or T pe Name
(I y 0 L A �" �' RECEIVED
Mailing Address �� O
L r°, I g3o.�. S,C, �- JIIL i1 ZQ15
City/State/Zip
--I b S-1S G�3)
Telephone Number
—7— 2.0 ,1 S
Date
(Revised 611812012)

I` have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSE® DEVELOPMENT
ENT
lua/ proposing development mast fill in description below or attach a site drawing)
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) dja
Sigmt re tune
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