57452D - Simpkins

C
CAMA / _ DREDGE & FILL
GENERAL PERMIT �� Previous permit#
JNew _ Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources f
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 1 Ito U
�yRukyt attached.
it Name � N" "{,'r�Ei 5 /r7-r p!,k %"7 c= Project Location: County d•�'t.,
`� h iP -- Street Address/ State Road/ Lot # s) Je
State_ ZIP Ad 1 `i'-�; h
/Fax # ()
!d Agent /?Y� 1: 4'! P ��1' ,'/� 'Oe' +-n
Cw
❑ OEA
❑ PWS:
M no
EW PTA ES PTS
HHF ' IH ❑ UBA ❑ N/A
❑ FC:
PNA yes CR>
Project/ Activity
dock) length
length
rmmber
ead iprap length
avg distance offshore
max distance offshore
channel
:ubic yards
amp
ouse/ Boatlift
Bulldozing
line Length
not sure yes /
ags: not sure yes CAd
orium: n/a yes
s: yes
r Attached: ye;D no
Crit/.Hab. yesG/
Subdivisio / I A r/�- '/ /5 _
City "0' I P ZB
Phone # Fl/0 -21 Y3 River Basin
�J�/
Adj. Wtr. Body / o �Sa'� �ie•►�/�if' (nat
Closest Maj. Wtr. Body
0
(Scale: /"
ding permit may be required by: ""/, / /❑//Sree note on back regarding River Basin
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NCDENR
North Carolina Department of Environment and Natura
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director
Date A54- a i
Name of Property Owner Applying for Permit:
� � �= S �irr► r7,�1 �' N 5
Mailing Address:
lDz1/ y
Z 9 <1�/3
Resources
William G. Ross Jr., Secretary
r
I certify that I have authorized (agent) —V' 5 ,J t2 to act on my
behalf, for the purpose of applying for and obtaining all CATNIA Permits necessary to
install or construct (activity
at (my property located at)
This certification is valid thru (date) -j � 3
?fir
Date

Name 01E Individual Applying For Permit
Address Of Property: / U
(Lot
2I
1 hereby certify that I own y pro ertadjacent property 7 to the above -
ref erenced property . The individual applying f or this permit has
described to me as shown on the attached drawing the development
they are proposing. A description or, drawing, with dimensions,
should be provided with this letter.
I have no =;m
his proposal.
2OI
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as-, nn ehj=C' inn if vO7 n,A-,+c haan npt;fim� 1� C"Prt;fio❑ T�",p,l
i Understand that .a pier, doeh, -ma0ri329 'pi.lin9s , brearwa ;er, boat
m se o=.boat 21ft must be set bacr a r_mu= d=Stance Of .=5' from
=y area Of =i.parian access - u:tjeSs waive �y .-me. (I_ you wish to
wai' a ha setback, you xcu-n- -;L'3 ir-I the cDp=OP=? g.te blank bEtlol,% )
Qr ' Z do wish Waive `he _5 ' Se :bask "ecru romen .
r .�
T do ant wish to waive the 1S' sszbagk -reCjui cement_

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- D _
plicant:
te:
5iv�l�i�s
Permit #: S� q 5--�
Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
itat Name DISTURB TYPE Disturbance total
One includes any
or
impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
Feet
for.
nce
des
7dA
ated
n or
cts)
FINAL Feet
(Anticipated final
disturbance.Choose
Excludes anyanticipated
restoration and/orrestoration
temp impacttemp
amount)
Dredge ❑ Fil L Both ❑ Other ❑
D
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

%IPKINS
SIMPKINS
ity Dev Sys
d Bay Rd
, NC 28443
d
0934
66-21/530
BRANCH 77830
Dace
J $ e,1� a ► a�
O�
Dollars
2WHOVIA
chovia Bank, N.A.
hovia.com A
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