Simmons, Rusty 87382C

N9 87382 A B C D
°FC°AS'"l ❑CAMA ❑ DREDGE & FILL
Previous permit
' Date previous permit issued
2 = GENERAL- PERMIT
❑ New ❑ Modification ❑ Complete Reissue ❑
Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental conce fn p vrC ant to: es
15A NCAC
❑ Rules attached. ❑ General Permit Rules available at the following link: wr
Applicant Name
Address
City State ZIP
Phone # (_ )
Email
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ IHA ❑ uW ❑ SPIMA ❑ PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Floating Platform(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
x distance/length
-hannel
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
(nat/man/unk)
Adj. Wtr. Body
Closest Maj. Wtr. Body
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
W�h W
1\may\ LY TO THIS PROJECT AND REVIEED COMPLIANCE STATEMENT. (Please Initial)
c��y
Permit Officer's PRINTED Name
0�
ca of permit" Signature
.
Check #/Money Order Issuing Date
Expiration Date

;1°=``°AS"1 ❑CAMA El DREDGE & FILL N9 g73g2 A B C D
,o
y GENERAL PERMIT Previous permit
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/C.AMAruies
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
(Scale:,, „_ )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature
Issuing Date
Expiration Date

tkiv-112:14
Name of Property Owner Requesting Permit:
x Mailing Address: som I'-", k ` w'.
145
Phone Number:
6 (�- a
�( Email Address:
X
I certify that I have authorized
S�. M�
Agent I
ntractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: s l I / 0Lc11)
at my property located at � J"�A f'�✓ 'i�i��%�� 7V
in 6 %>t�7T�/Z�- 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 I rmation:
Signature
Print or Type Name
Title
Date
RECEIVED
This certification is valid through ! I MAY 0 4 2022
DCM-MHD CITY

1-12' -1 b 09:36 FROM-
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T-063 P0001 /0001 F-145
DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL -RETURN RECEIPT REQUESTED
I hereby certify that I Own property adjacent to
Property located at. (�6l AY (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
in1RlE_Z07
(Waterbody) N.C.
n Pty/Town and/or County)
Agent's Name #: g-CA-35
Mailing Address:
Agent's phone el
= �3
He/She has described to me as.shown b®low the development helshe is proposing at that location
and I have no objections to the propo6ai. ,
--- --------------- ------
----------------------------------------------------------------- ---
DEscRiPTION
AN
(Individual D/OR DRAWING OF PROPOSED DEVELOPMENT
proposing dov®loprrient must. f"' in description below or Q attach a
� isite drawing) r
5( , ce' � c;•� �
(,�-
If-- -era v6prr
Lir�i t� ��ISi Irk �
SL,I f
- -• v �w���uons ro what IS -being proposed, youmustnotlf�the Divl$lon of coastal Management
(DCM) /n W1111ng Within 10.days of ►eceiPt of this notice. confect Information for DCM oNlces is
av�llableath :1/i�vww.rtccoasralmarta r►� nt.rleUweb/cm/stxfiilsfin orbycalling1�888.4RCQAS%
No' res onse 1s considered the same.as no ob action i! ou have been notified by Certified Mall.
(Prope ner Information)
Signature
X orLr4sypry Sri��c�s
print /T/e Name
I1/7011 A
cltyistato I
G-qo 6 o- G
Tf) 10ne Number/,E'mail Ad
dross
Date
(Riparian Property Owner Information)
__A_ : 1
I to tL-Q 14e),S
Pnnt or Type Name
Malting A dddress
ty,/,Sfate/Z p
Telephone Number /,"mailAddmss
OLI-z 4- Z 2-
Date
(Revised: Aug. 2014)
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MAY 0 4 i0Z?
DCM-MILD CITY

i 1-12' '1 �D 09:36 FWil-
T-063 P0001 /0001 F-145
DIVISION OF COASTAL .MANAGEMENT
CERTIFIED MAIL -RETURN REGEIPT,R
1 hereby x certify that 1 own property adjacent 1 to � p
. I 1 (Na a of Property Owner)
property located at �� �, �'�% ��' l J' � ` S
(Address, Lot, Block, Road, etc.)
on in l �� %iI�G� 64 P ( l , N.C.
(Wat®rbod,,yp) (City/Town and/or County)
Agent's Name #: a3 Mailing Address:
Agent's phone -I;,-
He/She has described to me as.shown below the development he/she is proposing at that location,
end I have no objections to the proposal.
------- - ----- - _-
-_•--------------------------------------------- -- ---
D1=SCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing developr»ent must fill in description below or attach a site drawing)
�y i /. OfJ
S (4( .
rave ovJecti"ons to What is being proposed, yorl mars
in writing within 10days of receipt of this notice.
IBsthtto:/hvwwn�.•.,9�ra�,...,..�--------• . ,
onse is considered the same ,
(Prope ner Information)
Signature
Pant or Type Name
Marling Address
-k r 64
I 5(--Lk� w
Itylstato ip
Telephone Number/ Email Address
De&
M
1 IJ'�,.I,
.,4" r
gtrty the Division of Coastal Management
Contact information for DCM offices is
taff iistintr or by calling 1-888-4RCQASr.
f (Riparian Propert Owner Information
Signature
,Print or Type Name
U
3v 1 ►3 . N�'�b/zT
1----,
" Mailing Address
City/state"Zip
Telephone Numberl Email Address
-a ;
Date
(Revised: Aug. 2014)
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MAY 0 4 2022
CCM-MHD:C1TY