Tompkin, Ralph

ti
7CAMA / ❑ DREDGE & FILL
No 70421 A B (Z D
r. GENP-RAL PERMIT Previous permit #
E�Nevv ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources C m fission in an area of environmental concern pursuant to 15A NCAC /J f les attached.
Applicant Name { `` Project Location: County
Address h °' f P Street Address/ State Road Lot #(s)
-r
City
E, E: State ,/cl ZIP >�/;- c re C' f
Phone # (�) E-Mail
Authorized Agent 4, '/ I ft" -`
[ICW 2-g % DJV I A ❑ ES ❑ PTS
Affected AEC(s): ElOEA ❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS,
ORW: ;yes / no PNA yes / no
Subdivision tt
City Q c " : + -- ZIP
Phone # ( )
River Basin
Adj. Wtr. Body_ a -` ; i' (nat /man /unkn)
Closest Maj. Wtr. Body {� -
Type of Project/ Activity r
(Scale:
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
Boat ramp
Other
Waiver Attached: yes no _
❑
t -^ ' See note on back regarding River Basin rules.
A building permit may be required by: 1
( Note Local Planning jurisdiction)
Notes/ Special Conditions f {
i
Agent or Applicant Printed Name
Signatw`je Please read compliance statement on back of permit"
if
j
Application Fee(s) Check #

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 1) 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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
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)
http://portal.ncdenr.org/web/cm/dcm-home
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington 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)
Revised 7/06/ 17

Apr. 17. 2018 2: 01 PM
AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
X0 5
Name of Property Owner Requesting Permit: ('
Mailing Address: bv
Phone Number:
Email Address:
I certify that I have authorized Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
1
necessary for the following proposed development: n
I A
at my property located at
Jr%fft
in lijai County.
l furthermore certify that I 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:
Sig ature
r
Print or Type Name
Title
Date
This certification is valid through / l_ —

Apr, 17, 2018 2;01PM
j1�y r
ADJACENT RIPARIAN PROPERTY OWNER STATEM NT /1
's
I hereby certify that I own property adjacent to
­�- . /Narne of Pr perty Owner)
property located at
(Address, Lot,
on in
—
(Waterbody)
ck, etc.)
(City/Town and/or County)
N-C.
The applicant has described to me, as shown below, the development proposed at the above
nIF
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
sr`A deveio r er>Ft r�aast fill:r'+t desc�ipf%n below cr aitach a site d awi pg
(%0divxaW 0a -pl1Po
C-1s tp -. en 1c,• �c
Y�r
�9a &1
C 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 give the setback, you must initial tunless waived by
me. (If you wash tohe appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement-
(Propejty Owner Information) (Adynt,property T
r intormaxion)
Jar w c ��
Print or e Na _ I �
,&bp Q W
Maili Ad Tess !C u�
city/st t ip, !
- � ao3 s
Telephone Number/emell address
Dore
`Valid for one calendar year after signature'
Sijnaita-ems 'linp ✓' /rlei/n
Print or
ANele in Addre �C
cft y/st Ip C /
Telephone Num er/eme;l address
Dote"
(Revised Aug. 2014)
�4_1
33 �b

Ap r. 17. 2018 2.01 PM
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ame of Prope Owner)
property located at�'�
(Address, Lot, ock, Roa , etc-
on N.C.
Ind and/or County)
(Waterbody) (City/T�wn a tY)
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 -
or..
(indiv%dual poopg deve�pret?ar rraasf fill rn dpscrrption below or:attach a site dwfnq
Ik4�
.
`�0
C)
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)
(Adjacent Property Owner Information)
Signarz&e *
Print or Type Name
PRnt or T � me C ] �Q
Mailing Address
Marling few N (�
City/5tate Gi(ylState2ip
r ) Telephone Number/emailaddress
Telephone Num erl emall address
Date
(Revised Aug- 2014)
*Valid for one calendar year after signature'

Apr, 17,2018 2:01PM
4
U.S. Postal Service" ECEIPT
CERTIFIED MAILO RE
-0 DOmestic hiall only
er
Er
C1.2MI
2f,
Ln
rn ra $eNicvs Dox, add f"
pievA SOC61 a p
C3 FM,,, R.CGIPt (S HarG
go MWI me S
Cn C]Acujtsvngl- fl-u1`0
0,,, gtpnyture Fkwllr;ted D-"
poerage $ o . Alt
14/17/2018
60 $ t', 6afAge nAd ees
rn $6.70
--0 ---------- — ------ --------
ED �Xipb, W -------------------
i;iry; hero, L
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Apr, 18. 2018 11: 02AM
No 3262 P. 1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 1
�0 ��
!hereby certify that I own property adjacent to �- s d�
ame of Property Owner)
?roperty located at � {� �r -r
(Address, Lot, ock, Road, etc.
orl 1 , in I -)a m UM) N-C.
(Waterbody) (City/Town and/or County)
71,e 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 t57/ in desorption below eraitach a site drawing)
54714
6>
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)
(Adjacent Property Owner Information)
Cio o I �/
Si�iiati0-E�
PICHMD 0L1P14A'%11
Print or T e hfame
Print or i ype Name
iLleiling,4 re s , '
Cq
MailingAddrsss
k p6piN�4 A�C 2 9S'k+
- -
cityl5rat 2 U3'S
r
cry s 373 ^B022Q
i eleohoi7a /Vu eryemeil eddress
i clephone Numberlemai! address
,4- l(- 3
'-/ S�! / R
Dace
Dare'
(Revised Aug 20f4)
'Valid for one calendar year after signature'