61586D - Simmons

LAMA / _ DREDGE & FILL V `v� • 61
ENERAL PERMIT Previous permit#
iNew ❑Modification ,jComplete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC rT G
O Rule attached.
t Name 4 ✓ 7 "'1l 17A !TN Project Location: County /` L
woe Street Address/ State Road/ Lot #(s)
,Zi�j ! State A'/ : ZIP 7 ir
# ( )��11� "" `� Fax # ( Subdivision
ized Agent f� City ZIP �G
d Cw EW ,'_;PTA LEES PTS Phone # ��) — d� ver Basin n�
OEA HHF IH UBA N/A Adj. Wtr. Body d ,u. I / nat
PWS: -'FC:
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
A Project/ Activity -1G /% S
ock) length
m(s)
pier(s)
Ipngth
umber
zd ,prap length IS_
vg distance offshore
iax distance offshore;
channel
ubic yards
imp
)use/ Boatlift -
Bulldozing
ne Length
not sure yes -
i
gs: not sure yes
mium: n/a yes
1
yes
Attached: i yess)
ling permit may be re(
(Scale: / / I

alicant: +�A J j j) S / O•✓S Permit #:
`.e: 7
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
kat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance_
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑
Fill
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other;
9(/
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑

,L DREDGING, LLC
72
15
y, NC 29460
31
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BBBT
BRANCH BANKING AND TRUST COMPANY
1-600-BANK BBT BBT.COM
66-112/531
2978
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DOLLARS 8
AUTHORIZ SIGNATURE
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?guy t:0 5 3 10 L L 2 11:000 5 LOG L 3 28 38115

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: l S-3 rAa P w,z lc Zl2 � a° S ��, A -rerf,
(Lot or Street #, Street or Road, City & County)
Applicant phone #: Z2Z4 97 C, Mailing Address: .?7-,)5- F�,O,,7D ,P „71, �6143
/ t (/'/0' 'y ( --- 832fs
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 at www.nccoastaimangement.neticontact-dcm.htm 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, 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.)
040 1 do wis h to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
(R' arian Property
%Owner Information)
Signature
-2 V l y-1 /6 //7i- A L-,1;
Print or Type Name
'-1 �� 5-
Mailing Address
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: LGt „A /,Y-"rnor��
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 4910)5-y0- P�2 (P 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 at www.nccoastalmangementneticontact—dcm.htm 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, 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 wis h to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
(Riparian Property Owner Information)
Signature
/- z-'2.wt A 1L) v S L'
Print or Type Name
Mailing Address Mailing Address

AU
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date _ 7-5=-13
Applicant Name 01), ,P 'K S,'"'---,,T5
Mailing Address ,,?7a,- �- �« 5 /<.�
1 certify that I have authorized (agent) jo:A to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)1_.-3 fA-
r
This certification is valid thru (date)
Signature ���'

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