74116_David & Rosale Sims_20190911

, cAMA/ DREDGE & FUL NO. 74116
ENERAL PERMIT ID* 0y'-G3 Previous permit#\h:IAA
)C w ❑Modification ❑Com lete Reissue ❑Partial Reissue Date previous permit issued 14 a
e p
As authorized by the State of North Carolina,Department of Environmental Quality �q
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC V 7)1 • ))b 0
❑Rules attached.
Applicant Name IAU II i 4 t®S if L 1: 5/M ? Project Location: County PAM j)(U Co`"A' / j
Address V 5 Pi R A i COL/ ( j R(L / Street Address/State Road/Lot#(s)
City 0Q1 fN 7-'8t- State /11( ZIP 2 8577 ( 5A M1
Phone# (/I ) /?° — /7�s E-Mail Subdivision
Authorized Agent ``� City
ZIP .
��
(CW W PTA S I PTS Phone# ( ) River Basin N/it./ c f
Affected ❑OEA 0 HHF ❑IH 0 UBA ❑N/A
AEC(s): Adj.Wtr. Body 5y1 )17`? (R:L k if Oman /unkn)
❑ PWS: S� ) /
ORW: yes //no� PNA yes /� Closest Maj.Wtr. Body arc!Type of Project/Activity Au io/1 ) 71 /2 /OO uu[«F) P,
(Scale: ) 3o i )
Pier(dock)length F
Fixed Platform(s) I j ,I
Floating Platform(s) �_
Finger pier(s) i
Groin length
number j
Bulkhead/Riprap length "t'r � j ; r "S /r
avg distance offshore ©♦ i
max distance offshore 0
Basin,channel - I (
cubic yards '" T
Boat ramp --
Boathouse/Boatlift r r"i Sj hfh
4 j '! Cf
Pi'
Beach Bulldozing '-
Other ! ,
1 ��r
Shoreline Le 0 0 / 1 � � 1. i L t q h
' SAV: not sur= yes no _...-._-.-.. . !t~
I Li
Moratorium: n/a yes _I �; S 1---
Photos: yes n nff ,
Waiver Attached: yes g r
A building permit may be required by: 7 `rA L I((, CO u N . i I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions )_ C 0 )'), 1 J 00 c`A. 7f rip,/
/264A, ., ,Li}:- ,--)-6(A7- 1-/-4-- 61)id )-/NC'
Agent or App icant Printed Name PermitOffi r' nted Name
Q 5t / `..- 51:4/11. -/
Si nature f� .**Pe pase read com liance statement on back of permit** Signature
g4L1OQ OD 6 Y / i, (l 12'1 C O /ct )/ j ii,/ cc_) ZJ
Application Fee(s) Check# Issuing Date Expiration Date
t _

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to UQ it 1��?5C31 i C of
(Name of Property Owner)
property located at I O o� s P/ r arc- CO Ue (i 2 cie
(Address, t, Block, Roa , etc.)
on , in ()r/ecr-/ /l 4 Qs't 'IC1 , 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)
ILK( kk) PaCJ €6AGOal
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
I 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)
i ature t w� Si lure 0QU1 2bsal� I >7s kju s-�t Mart-, S
Print or Type.fvame Print or Type Name
100?5 rrettk Cock �] eCk / ') a3 PIrSe� (d r/c ( ./y-eic
nailing Address M ing Address
XJr/ re I/'-r�l 1NC'_ -2SS ?/ &rrc-n76 ( ✓7,/C' c?Y5-rJ ,
ty/State/Zip City/State/Zip
( O - 33o 15 7S 5- 5. 7/ / Ca T
Telephone Number/email address Telephone Number/email address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 02KU \CT) f Q�, I 5 I Ili 's
�) 1 (Namte of-property Owner)
property located at /n D�i ri 'r Co O C C , pq
(Address, Lot„lock, Road, etc.)
on , in CJ � e rL ,�t JQ Pth .I C, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
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)
'CNA 1j,ec�3 -eoc.<
Jo_(
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro erty Owner Information) (Adjacent Property Owner Information)
Gjl/�
Signatu e Sr nature*
c
I ,c�aYineJ LI \1/O,
Print or T pe ame Print or Type Name
16 A s rate_ L1 R d e_ I i n 4 ( E M ,or
Mailing Addles* Mailing Address
aJr/c-r�41 ) 11)C aSJ71 Or!'Pr, �-al N\C) !LT-
City/State/Zip n City/State/Zip l
Telephone Number/email address Telephone Number/email address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

Applicant:DAV) 0 d- f °SA Lt
Date: // sip'r
General Permit#: 7to G ,3
Describe below the HABITAT disturbances for the application. All values should match the name,and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq_Ft. TOTAL Feet FINAL Feet
(Applied for. (Anticipated final (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or temp restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
$Ifoi'eL t,E Dredge❑ Fill Both 0 Other 0 1 /)O F i / 0 ®Ic r
(6 i4 6 ROlo) Dredge❑ Fill❑ Both ❑ Other $. I ODoF! v
Dredge❑ Fill❑ Both Cl Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both El Other ❑
Dredge 0 Fill❑ Both El Other 0
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑