Simmons, Daniel 79617C

' i LCAMA ! DRY®Sx� &FILL gyp.O 17 � � A B (C 2 D
gF-'��RALPrevious permit#Modification ❑Complete Reissue OPartlal Reissue Date' Previous permit Issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in a rea of environmental concern pursuant to 15A NCAC 77 ff
Rules ched.
Applicant Name !✓ — Project Location: County
Address Street Address/ S to Road/ Lo
City _ State 71P
Phone:
A l -Mail Subdivision_*-�_
4Authorizedlgent _ � ...._ ... ...._.__ T_ Citypf ZIP !�` _-
Affected*CW. W*TA ❑ES QPTS Phone # qRiver Basin GtAEC(s): DOEA ❑HHP ❑Ik nusa OM/A Adj. Wtr. Bnn(_.(slunkn)
0PWS: J J
ORW: yes / n P6VdA yews no Closest Maj. Wtr. Body —
Moratorium: n/a yes no
Photos: yes noj✓ I L /�,,,�+ } -
Waiver Attached: 36
yes (4� 7-FG1-••...t� �-�:`
A building permit may be required by: I_ See note on back regarding River Basin rules.
( Note Local Planning Jurisdlctioi r> A n j i,, � _ e n � /\.� d �( zi .`,` +t / f f Ar r t�/
compliance statement
i issTuh DhtV r ' kxpl6tfon Date

N�CAMA / ❑ DREDGE & FILL N? 79617 A B C D
rewNERAL PERMIT Previous permit #
❑Modification ❑Complete Reissue ❑Partial Reissue Date p evious permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ` i
and the Coastal Resources Commission in a rea of environmental concern pursuant to 15A NCAC `
i 00
Rules ached.
Applicant Name Project Location: County
Address Street Address/ S to Road/ Lot (s)
City i State ZIP '
Phone # -Mail Subdivision
Authorized Agent
�—
�CW
4wElOEA
Affected
AEC(s):
ElHHF
❑ PWS:
ORW: yes / n '
PNA
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) '7—
Groin length —
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards e--�
Boat ramp
Boathouse/0 oatlif �E�l"lam
Beach Bulldozing
OtherI
*TA ❑ ES ❑ PTS
❑IH ❑UBA ❑N/A
Shoreline Length
SAV: not sure yes no -
Moratorium: n/a yes no
Photos: yes no _
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Soecial Conditions OL
or
no
City
Phone #
Adj. Wtr. Body-1 V
Closest Maj. Wtr. Body
Pri
0
a
❑ See note on
ZIP
(Scale:
�' /00
regarding River Basin rules.
read compliance statement on back
ication Fee(s) heck # I IsTTuAg DGt, - I kxpirati`on Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

N--Mr
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �70uC-� ��uG�S s
(Name of Property Owner)
property located at Zz 160 c.ULfNTt�`f �Ws 2a 'R C17,1y� ;-0,C7
(Address, L(?t, Block, Road, etc.)
on Z�S� in N14�� ��'1 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION .`
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or roin
must be set back a minimum distance of 15' from my area of riparian access unless waive by
me. (if you wish to waive the setback, you must initial the appropriate blank below.) r
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
�F
nature
ANI:t, S11*"45
Print or Type Name
6u)- 914H W .
Ag Address
jRf" M C(, I
City/State/Zip
A/ e 7 0551
Telep oneh Number/efnaiaddress
Date
(Adjacent Property owner imormaiiun)
J
St.svxayre, Z5
Print or Typ ame �J �9 ►�
-7� l/�f)]`,,,./
Mail' Add r ss _
City/State2ip
Telephone Number/ email address
Date*
(Revised Aug. 2014)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to AflAm Cx4s riex 's
property located at 30- rAtln/TYLY C�t(a 1� AName of Property Owner)
pROF,tp erry ^/C n T
77 (Address, Lqgt, Block, Road, etc.
on ,Upoar TZ[VEtZ in AprPaao Ctry N.C.
(Waterbody) (CitylTown and/or County)
The applican has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description below or attach a site drawing)
5ar, 41'aft T""
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wis o 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.
(Pert Ow Information)
Sr* ature
ld�M(-K- StetA Qfi;
Print or Type Name
�i90- kid iT.
M fling Addre s
Drlof—kwp�[9
City/�Srat L41 S7
TelepGGhone NSumb r email address
ce % N%GlBC%�h,r�irJG int-'4i43I�exgm
Date
(Adjacent Prty Owner Information)
�/.aa /L CF�G3i✓/G /G
Print or Type Name
.3231, cArc
Mailing Address
106
City/Statelip
f/9-GGi-�0�/ �.vzer9cF�G.�✓.c,c, cam
Telephone Num erl email address
_3Z---��
Date*
`Valid for one calendar year after signature' (Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to —Am C N"VIGIL 's
Name of Property Owner)
property located at ?J0- d)C('iTYLY AVR&E40 Crry n!t y
77
(Address, Lgqt, Block, Road, etc)
on 1po2T %ZIVti2 -in YKPf>rtt6,l,p It N.C.
(Waterbody) (Citytrown and/or County)
The applican has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wis o 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.
(Pert Ow Information)
S' ature
�!(/UI Gc, s[M DNS
Print or Type Name
�i31;7- Nl*q Sr.
ZM fling Adore s
fling
r
C/C ;-z pS7
Telephone Numb r email address
�Sz-3yl-�%GSt� ritn,�wd m �i+�►1�jlc.coM
Date
(Adjacent Prorty Owner Information)
^44 t[ Ce-iG3N/G /G
Print or Type Name
.323G z44C 4100_P'f.e_P "P/L
Mailing Address
e. '5rl' � NG 2 a
City/Stat I.
Telephone Num er/ email address
Date*
'Valid for one calendar year after signature' (Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �OtJtC -�Akkw5 s
�� �A//_ �(Name of Property Owner)
property located at Z2- 160 U/�(NTe,( �6 R 1gf r7" 1 r NC dtf SC7
`� (Address, L t, Block, Road, etc.)
on 1 eoAlgo�t Poti. , in G:A N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELONMr-N i
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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.
(Property Owner Information)
Si,onaturee e
J1AA11e( tµA+>a�5f euAt a�S
Print or Type Name
6u2- 111tH sir-
g Address
A
City/State/Zip
Aic
Telephone ohoh ne Number einail address
Wr/iaa6;Nrc4w
Date 3//510z1
(Adjacent Property Uwneer inrunnaiwiq
J
Sc re-
u-
Print or Typ ame
Ma li Addrtss
City/State/Zip
Telephone Number / email address
Date'
(Revised Aug. 2014)

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