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Type of Project/Activity
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Town of Oak Leland
A Ruse
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' •—+�•-' V 4601 E Oak Island Or y
1 Oak Island, NC
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- ' t Phillip & Kelly Simpson
t — — Parcel ID 234FA009
1606 W. Yacht Drive
60' Right -of -Way Oak island, INC
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Earle Koontz
1606 W Yacht Dove
Oak Island, NG
TAR PAM INEUSENBUFFER (orde one)
St r Hide nn hei:. mj; rrdmj Rnr i Itamn rates
CJ tier .Iddfinn of not onddon•, on bad:
I AM AWARE OF STATUTES. CRC RULES AND CONDITIONS fHAr APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMEN to hntlal
/! ' •- n '.r;' kittTED ri.ap -- Prnuuf rtL� Name I
:mp ,r a.,f.,m.•m on baO of peanut Sip tur 1
ff„•V :q%1urr•y Ord„r Mu,ng DTteI t•PRapo" Ovtr.
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: t1h t i
Mailing Address:
Phone Number:
Email Address:
C.
V_
I certify that I have authorized Debbie Wilson, Agent ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Ci r/� �Gkr` her 11 act
at my property located at 1608 W. Yacht Dr., Oak Island NC ,
in ke; u l- s Ll-�, C /C County.
1 furthermore certify that 1 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 Information:
' Signature /
Print or Yype Name
i � Luke G S
Title
tt l _l r
Date
This certification is valid through I I
RECEIVED
MAR 0 8 N".; )
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Phillip & Kelly Simpson
Address of Property: 1608 W. Yacht Drive Oak Island NC
Mailing Address of Owner: 2215 Haigler Baucom Road Monroe NC 28110
Owner's email: ksim-pson79Bcarolina.rr.com Owner's Phone#: �704)363-1364
Agent's Name: Debbie Wilson Agent Phone#: (910) 612-0402
Agent's Email: debbiew75(cDcharter.net
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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.
ffi1 - I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
malted to 127 Cardinal Drive EXT, Wilmington, NC 28405. DCM representatives can also be contacted at
(910) 796-7215. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed 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 (this
does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign the
appropriate blank below.)
DO wish to waive some/all of the 15' setback
�qr L r4-
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: (�A.�-f�-•l�m�`1"+—
Typed/Printed name of ARPO: t. a rug- sl• l�.00� �t
Mailing Address of ARPO: 52 $ ,Tyra z ,z., W c6", SQ t i s Inc. rh , /V C a 81 y '7
ARPO's email: •�-r • 1<00�11�13[r� �,.1,•0.4n,ARPO's Phone#: L'7b'4):03 2c/3 1
Date: ;2 I.2a Iaz *waiver is valid for up to one year from ARPO's Signature`
MAR 0 8 2022
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Town of Oak Island
c/o Steve Edwards
4601 E. Oak Island Drive
Oak Island, NC 2846S
A. Sig Are
X El Agent
�--- ElAddressee
B. by (Printed Name) C. Date of Delivery
i /
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
D Priority Mail Express®
II
I
�IfIII
I'II
ICI
((III
I
I I I
�IIII
I'I
II
"III
I
❑ Adult Signature
❑Registered MaiITM
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
9590 9402 6667 1060 1216 80
❑ Certified Mail®
D Certified Mail Restricted Delivery
Delivery
D Signature ConfirmationTM
❑ Collect on Delivery
❑ Signature Confirmation
2. Article Number (Transfer from service label)
D Collect on Delivery Restricted Delivery Restricted Delivery
7020 2450 0000 7529 8669
7lnsuredMa
D Insured Mailil Restricted Delivery
(over$500)
PS Form 3811, July 2020 PSN 7530-02-000-9053
Domestic Return Receipt ;
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space
ed to: permits.
i • Article Address
Michael & Rianne Bell
P. 0. Box 282
Indian Trail, NC 28079
II I'III'I I'll I'I � 11 I II 11 I I I I�III I I it ill I II I III
9590 9402 6667 1060 1216 97
2. Article Number (Transfer from service label)
7020 2450 0000 7529 8645
PS Form 3811, July 2020 PSN 7530-02-000-9053
A. Signature
❑ Agent
B. Received by tinted Name -u ❑ Addressee
C. Date of Delivery
). Is delivery address different
deGve from item 1? C] Yes
If YES, enter
ry address below: ❑ No
�t-0 2 T"-- I,
-
3- Service Type
❑ Adult Signature
❑ Adult Signature Restricted Delivery
0 Certified Maile
❑ Certified Mail Restricted Delivery
O Collect on Delivery
❑ Collect on Delivery Restricted Delivery
❑ Insured Mail
❑ Insured Mail Restricted Delivery
(over$50m
❑ Priority Mail Express®
❑ Registered MaiITM
❑ Registered Mail Restricted
Delivery
❑ Signature ConfirmationTM
❑ Signature Confirmation
Restricted Delivery
Domestic Return Receipt
RECEIVED
MAR 0 8 2022
USPS Tracking
Tracking Number: 70202450000075298669
Your item was delivered to an individual at the address at 11:19 am on February 3,
2022 in OAK ISLAND, NC 28465.
USPS Tracking Pluso Available
Status
Delivered, Left with Individual
February 3, 2022 at 11:19 am
OAK ISLAND, NC 28465
Tracking History
February 3, 2022, 11:19 am
Delivered, Left with Individual
OAK ISLAND, NC 28465
Your item was delivered to an individual at the address at 11:19 am on February 3, 2022 in OAK
ISLAND, NC 28465.
February 3, 2022, 2:30 am
Departed USPS Regional Facility
FAYETTEVILLE NC DISTRIBUTION CENTER ANNEX
February 2, 2022, 11:52 am
Arrived at USPS Regional Facility
FAYETTEVILLE NC DISTRIBUTION CENTER ANNEX
February 1, 2022
In Transit to Next Facility
January 31, 2022, 9:32 pm
Arrived at USPS Regional Origin Facility
CHARLESTON SC PROCESSING CENTER
RECEIVED
MAR 0 8 2022
Air
January 31, 2022, 4:67 pm
Departed Post Office
JOHNS ISLAND, SC 29455
January 31, 2022, 4:16 pm
Acceptance
JOHNS ISLAND, SC 29455
RECEIVED
MAR 0 8 2022
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Town of Oak Island Retum
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4601 E. Oak Island Dr.
Oak Island, NC
Phillip & Kelly Simpson
Earle Koontz
Parcel ID: 234FA009
1606 W. Yacht Drive
1608 W. Yacht Drive
Oak Island, NC
60' Right -of -Way
Oak Island, NC
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1 Date De lted Check Fran (Name)
Nam. of P—M Holler
V ndm
Check number
Chock
amount
Permit Number/Commenm
Re.. W w Re/und/Rwllaceted -
Column2 Col-3
Column)
Co1umn5
Columns
Caf"n7
Columns
Column8
t2 Pressley Wicker
t2 Terry Turbeville
22 Welsh Construction LLC
ns
t2 Sea Dog Marine Construction
t2 Town of Oak Island
-of—Oak
2 Town Island _
t2 Phillip Sim son Jr.
same
same
Stephen Settle
Martha Khan
same —
same _
same
First ban_ k
8B&T
Comi Federal CU
First Bank
BB&T
BB&T _ _
First National Bank
2704
$ 200.00 GP #86079D
200.00 GP #85456D
$ 200.00 GP #85704D _ _ _
$ _400.00 GP #85538D _
$ _ 400.00 GP #85539D _
$ 200.00 GP #85540D
400.00 1 GP #85718D
PA rot. 16525
PA rot._17527
PA_rct. 16519 _
PA rot. 16133
PA rCt. 16132
PA rct. 16134
PA rat. 16135
1001
1657
_
87318
87317
_
1004