66695D - Simpkins

I CAMA / ❑ DREDGE & FILL ERAL PERMIT A B
31E 11�. T Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources //yy
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rule
LAC G
t Name /4 o�i? >r•a� �!/i f Project Location: County
r
ie Street Address/ State Road/ Lot #(s)
AS-�/ s'/'-staState ZIP
167—r/O )4v' v 116WI4 E-Mail Subdivision
f -7
ed Agent _ •s f l'�Gv t �:u City �% / s-�� �� ZIP
❑ CW ❑ EW ❑ PTA �`R9s ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
❑ PWS:
yes / no PNA eyD no
Project/ Activity
:k) length
rtforril(s)
Platform(s)
er(s)
igth
nber /
i/.fzprap length
distance offshore
x distance offshore__
annel
4 yards
ip
se/ Boatlift
dldozing
Length Y
not sure yes 1.9
um: n/a yes
yes
stached: yes
Phone # ( '-"' River Basin ric
Adj. Wtr. Body77
i'!rr.c. jtl"at+/r
Closest Maj. Wtr. Body
(Scale: _d
ig permit may be required by: '� � W ❑ See note on back regarding River Basin
_ocal Planning jurisdiction)

NC Divisi®a Of G®astal .M9t. Habitat impact computer sheet
Applicant:
Date: —�
Describe below the HABITAT disturbances for the application.
,All values should match the name, and units of measurement found in your HabitSq.
code sheet Feet FIN
TOTAL Sq. Ft. FINA q Ft.
hed for. (An'
(Applied for. (Anticipated final (Applied .
Disturbance dist
DISTURB TYPE Disturbance.total disturbance. includes any total includes . Exc
Excludes any
Habitat Name Choose One anticipated restoration any anticipated rest
restoration or and/or temp restoration or tern
tern im acts im act amount tem im acts am
Dredge ❑ F' Both ❑ Other ❑
Dredge ❑ FIII ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill Both Other
El ❑
Dredge. ❑ Fill ❑ Both ❑ Other ❑
II Dredge ❑ Fill ❑ Both ❑ Other ❑

(,A, (or Y-
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
A _ % ,
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
-, We) -4
or Street #, Street or Road, City
Mailing Address:
I hereby certify that, i own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing,with dimensions must be provided with this letter.
Af!�l have no objections to this proposal. . p p T have objections to this proposal.
Ifyou have objections to whatis being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at httpYlwww.nccoastalmanagement net/web/cm/staff-listing or by calling 1-888-4RCOAST.
No response Is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand thafa pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you w' h to ive 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.
n)
MA
lelz I �Lvr;Al
tint or Type Name !
d 3 t dll r
Wallinq Address
(Riparian Property O r Inf ation)
ignatur
Print or Type Name
fi %

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
%ei � C( �1�/
i of or Stre- t or, oad, City & Co )
e ` V, � �% ,f xg
Mailing Address:
I hereby certify that. I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttpJ/www.nccoastalmanagement.net/web/cm/staff-listin_g orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
1 do not wish to waive the 15' setback. requirement.
(Property Owner Information) (Riparian Property Owner Information)
Signature / Signature
Print or Type Name Print or Type Name
4 /� V'3z -ter
!l;2� �, . w.. �. l/1 /�i��i .,/7�.,_ .. .ram„ ri.,._ .�✓.

RIB Marine CONStrICUOR
Invoice I" draw
For; Mr Rod
Item
Provide and drive
Permits
Total
Material cost 50%
Measurements
58x12
Mallard Bay
[phone]
Price per linear ft
155
Total
89"
525
9515
4757 )
This price is subject to change due to undisclosed or unforeseen subsurface obstructions.
�) (1//,)/ m

N
5W -�s