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Home My WebLink About68042D - Simpsonf' CAMA / ❑ DREDGE & FILL .1: ; A B GENERAL PERMIT Previous permit # ).New [-]Modification I ]Complete Reissue El Partial Reissue Date previous permit issued )rized by the State of North Carolina, Department of Environment and Natural Resources �` 7 Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 07T ZW ❑ Rules attached. it Name Ar x M05ay\ Project Location: County_ ; ;r 9G/ ,m�a ,r�111 (A - On rot State t6C ZIP Z811 (*q) ZZ j - 34 Z 1 E-Mail ted Agent r—W c�u� ooSkG/ // I I ❑ CW iW YPTA ❑ ES ❑ PTS ❑OEA ❑HHF ❑IH ❑UBA El N/A ❑ PWS: yes /'not. PNA yes f Project/ Activity W Street Address/ State Road/ Lot #(s) Z L--1' �o� � (.4 in Dr. Subdivision 1 City 1L 1g (.w.a ZIP Phone # ( ) River Basin L r(Z Adj. Wtr. Body � C r� 1Q,C - I �� Q� (nat � Closest Maj. Wtr. Body W (Scale: I ■��■■■■■� 1■■■■■■■■■■®■t■■■■■ ■■■■■■I ■ti ■■■■■\�■■■■■■■■■■®■■■■■■■■■■■■■I ■�■■■Y■NIA■■■■ is■■��'a■L��.'r■■■■■■7 �M■■■■■■■■1�� ■■�■lyJ /� ■■■■■■■■■■G :1■■■■■■■■� ci■■■®■■Ca //■■■■■■■■■■R ■■■■■■■■1/■■■■!■■■■■Infi�lil ! ■I IF IOK"M r..iiiiiiiiiii�-�■ . i�i ■�■11■ I d■�■■■1 ■■ �r r�r�r�r��rr�r�r�r� r�r �r ��N.� iii�lsr7■G�i ■■G�.i■■ �\i�r�nll:��■i��71 ■■o■ MEMO ■■!!! �:.�■■�■■■1 ■■■■■■■■■■■■■■ i■■■Y��I:z��.Z-'�1 \1■■■LJ■WI�IiairtMiMii ---�••�,•■•�■�■� ■■■■ No ON /1i■■■LJ■■■■■■1 • ■■■■!J1 ■■■ ■■ MEN �40■■■■ 0■■�11�1 ■■N■��■I■■■■■■■EM��■■■■■■■■■L�r/i ■■■■■■■■■■■..a■■■■■11■�■■■1 'ng permit may be required by: nAV 75(40 ❑ See note on back regarding River Basin r Local Planning lurisdiction) — 3/13/2017 Comments First Permit 5 of 5 Allied Marine Citizens GP 68042D Contractors LLC Alex Simpson Bank 5385 $1,600.00 @$200 BS NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: �I S;rn j�� Permit #: 80 `� Zrl, 'l Date: 001 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 Habitat Name 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) cW Dredge ❑ Fill ❑ Both ❑ Other W oceq ODredge ❑ Fill ❑ Both ❑ Other ❑ z G T G Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ CDaits Dredge ❑ Fill ❑ Both ❑ Other ❑ M H C D 0 Tyler Crumbley LPO Tara I ✓ I ✓� Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑. Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill [] Both ❑ Other ❑ „ DW Review Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Owner �V Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both E] Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Name of Property Owner Requesting Permit: Mailing Address Phone Number: Email Address, ivy- ;2.2/-U,2_1 i certify that l have authorized _ r/�l'e j 104 � Agent / to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: _ n at my property located at ___ ,; . ► in k_ County, l ful'ftrmore certify that I am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. ProPerty Owner InfornYation- Print or Ty Name rive ` 2 11.3 /__L� CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner Address of Property- ei Al%A Z/- (Lot or Street #, Street or Road, City & County) ` -L Agent's Name #/%,;;� /'i�►'�Yi Mailing Address Agent's phone #: j/� J.4 3u l��^ , ,/f4G- ) 8yor hereby certify that I own property adjacent to the above referenced property. The in ivi ua 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, mus._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 at fnto:%twww.nccoastalmanagement.net/webicrn/staff-listinu 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 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. I do not wish to waive the 15' setback requirement. (Propp7r)ty Own r Information) .Signature %� Print or Type Nam �— Mailing Address M -., (Riparian Property Owner Information) Signature ,yam Print or Type Name Mailing Address /'/_ /, 7_- / / Is2,and 3. 1 address on the reverse etum the card to you. to the back of the mailpiece, ` space permits. ro �n %w�nci fqyarn {xnccvLhwck �/ G 0319 5155 0689 14 ansfer from service labo A. --E��nt S' t ,0, A ❑ Addressee B. PWAved by (Printed Name) C. Date of Delivery PA iA� S':) 4 9 o 3 A tj l* 1 �, rj z ?- S `, D. Is dsh y address different from item 17" ❑ Yes If YES, enter delivery address below. ❑ No 3. Service Tjfpe • Adult Signature • Mult Signature Restricted Delivery ertified MaittD Certif W Mail Restricted Delivery • Collect on Delivery • Collect on Delivery Restricted Delivery 5 3010 0000 ? 8 4 8 7566 rricted Delivery 0 Priority Mail Expo Registered Mall*" CI Registered Mail Restricted Delivery ❑ Return Receipt for Merchandise • Signature Confirmation''m ❑ Signature Confirmation Restricted Delivery ?ri12015 PSN 7530-02-000-9053 Domestic Return Receipt 1�0 Zfl f f do , 11