25101D - Simmons

- CAMA and DREDGE AND FILL
G E N E R A L ID
PERMIT N9 25191-r
as authorized by the State of North Carolina
• Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC r-1+1 1100
Applicant Name e 4 c j,,,,,re-Nor„ Phone Number c11 tt Elf--} -Eitg8ej
Address r 3 I C PGI A f L Prr,d n 'u rld 5 t..J
City ` lA C\ State ) Zip ot9yCo2
Project Location (County, State Road, Water Body, etc.) "Br„ (..yvj tcL ( o0dA41 r --EE IIAr-,t1 r54,
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Type of Project Activity G.-1 1 Ne,,,,j b>>,10 c ci rek\Arc.me.....* or 661 `1 nc\ 6(ilt e- 11
PROJECT DESCRIPTION SKETCH (SCALE: ' 1 •T )
Pier(dock)Length _ ( - t
Groin Length
number _.....
Bulkhead Length 31 t _ •
max.distance offshore
Basin,channel dimensions
,
cubic yards b __ a
__IR: : 1
i k
Boat ramp dimensions ,-1 4---
CZ-4
Other r ,..... .,.. _ �� KUt
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t
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g ,a, 1 o y. I F
` • -b-.........
12' &''
ill
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avort- 1 ;-,„,„,,..4., 44 , ... , ,
_ ....._ _.. . ,
This permit is subject to compliance with this application, site drawing
and attached general and specific conditions.Any violation of these terms
, // r applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
may cause the permit to become null and void. --rY�
This permit must be on the project site and accessible to the pern it of- permit officer's signature
ficer when the project is inspected for compliance. The applicant certi=__. 1 w U U 4,,,,,,,,,...1- 1` Z«,V
fies by signing this permit that 1)this project is consistent with the local 1 issuing date expiration date
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they r7O • i 1 00
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project `tb3O. l
is consistent with the North Carolina Coastal Management Program. application fee

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SENDER: I also wish to receive the follow-
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SENDER: I also wish to receive the follow-
o Complete items 1 and/or 2 for additional services. ing services(for an extra fee):
Complete items 3,4a.and 4b.
❑Print your name and address on the reverse of this form so that we can return this ai
card to you. 1. 0 Addressee's Address •U
❑Attach this form to the front of the mailpiece,or on the back if space does not E
permit. 2. ❑ Restricted Delivery rw
❑Write'Return Receipt Requested'on the mailpiece below the article number.
❑The Return Receipt will show to whom the article was delivered and the date _a
delivered. N
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3.Article Addressed to: _ 4a.Article Number cc
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1TSigna (Addressee or Agent)
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P orm 381 ,December 1994 102595-99-B-0223 Domestic Return Receipt

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1f BELLAMY SHRIMP & FISH _ 1004
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PH.910-842-8888 .
1319 CEDAR LANDING RD. S.W.
.I SUPPLY,NC 28462 _// 66-12I5/531 '
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