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HomeMy WebLinkAboutSimmons, Rusty 87382CN9 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- if 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) I I 'i i j { REC NDO 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) j .i { I i i s 1 1 i l MAY 0 4 2022 CCM-MHD:C1TY