60737D - Simmons

CAMA / ,DREDGE & FILL / NO. 6(
GENERAL PERMIT V Previous permit#
flew JModification -Complete Reissue Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
nt Name Sifjo/f �is�IsWrs /�' %/'• Project Location: County /��O, E-1 �G
s / l3GD /ADS /?��yl�� S"G/ /► C' Street Address/ State Road/ Lot #(s)
(dt�N State //[ zip_�
# ( 2 V1—�Fa�x # () �� Subdivision `�l-�// �/ fs
ized Agent / 7�jyij/ City zip Z�
d Cw EW PTA DES PTS Phone # ( ) �!
River Basin s
OEA _ HHF IH UBA ElN/A
Adj. Wtr. Body-
yes / no PNA yes no Crit.Hab. yes / no Closest Maj. Wtr. Body
of Project/ Activity
iock)length
pier(s)
length f(
camber
:ad/ Riprap length
wg distance offshore
nax distance offshore
channel
:ubic yards
)use/ Boatlift
Bulldozing
ine Length-
not sure yes moo+
igs: not sure yes
)rium: n/a yes -
C - no N
Attached: yes
ling permit may be required by:
(Scale: / �'
❑ See note on back regarding River Basin
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North Carolina Department�vv0ft&B9ocnNC2Ma
Division of Coast
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AGENT AUTHO
Date:. ✓+�'`
N e of Pro�rty Owner Ap in9 for Permit
owner's M{ 01-lin A?Q ens.
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Phone Number
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Name or.,u.,,�.._
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Agent's MaRing�A/ddress"bv, / a
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Phone Number —
thorized the agent listed above to act on my behalf, for the purpose of applying
I cattily that i have au
for and obtaining all CAMA Permits necessary to install or construct the following (activity).
'my property located) at
Property owner Signature
RECEIVED
DCM WII MlMrrTnni nit-

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FOF
Name of individual applying for permit -
Address of property '�V q/.7'A'4 A/ /)D0 W icAIR J
I hereby certify that 1 own property adjacent to the above referenced property.
individual applying for this permit has described to me as shown on the attache
drawing the development they are proposing. A description or drawing, with
dimensions should be provided with this letter of notification.
Please initial below if you have no objections
����
• I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 9�
within 10 days of receipt of this notice. No response is considered tl
7--16 YdIf same as no objection if you have been notified by Certified Mail.
WAIVER SECTION NIA
i understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must be set back a minimum 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. RECEIVED
DCM WILMINGTON, NC
I DO NOT wish to waive the 15' setback requirement. 0 9 2012
Signature & Date

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CAOYVII�L
F&S Marine Contractors, Inc.
Complete Marine Construction Services
For Over 37 years!
CAPT. ED FLYNN DURWOC
Piers, Floating Docks, Pilings, Bulkheads,
Boat Lifts, House Pilings, Repairs
P.O. Box 868 Phone/Fax: (910)
Wrightsville Beach, NC 28480 email: efly(e
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C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: P"d-< -�>147P"A- S Permit
110 1
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
bitat Name
DISTURB TYPE
Choose One
Disturbance total
includes any
anticipated
disturbance.
Excludes any
restoration
Disturbance
total includes
any anticipated
disturbance.
Excludes any
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
Dredge ❑ Fill Both ❑ Other ❑
301oU
3�w
Dredge ❑ Fill ❑ Both ❑ Other ❑
■ Complete items 1, 2, and 3. Also
item 4 if Restricted Delivery is de
■ Print your name and address on
so that we can return the card to
■ Attach this card to the back of tji
-- -- ♦L- .--. :L --------- ..-
1. / Ul W f UUIVPbWU LU. \
l�ln, �y�1yyirv► �� �.
Ox� Ms 38G5�
f If YES, enter delivery address below:
L Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
r-, r-1 — — —
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑