67138D - Tomlinson

],CAMA / lQ DREDGE & FILL A B
l� 1
PENERAL PERMIT Previous permit# k:
ew ❑Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Ru��`s attached.
it Name ��� /In ��� l + ✓� So /^ Project Location: County ECG
3o 4, Street Address/ State Road/ Lot #(s)
y v%' .
1 Q�
�'(� ) 276- y?74 E-Mail Subdivision
zed Agent (5T • 44--to City - s AGO ZIP �'�4
i ❑ Cw � �pTA UES ❑ PTS Phone # ( ) — River Basin l^,
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ WA AJ
❑ PWS:
yes / no PNA yes
if Project/ Activity
pck)length
'laifprm(s)
ength
umber
ad/ Riprap length I '
ig distance offshore
iax distance offshore
:hannel;ZO K /vo X
ibic yards ' !4/
inP
use%oatlift
Bulldozing
ne Length j
not sure yes
mum: n/a yes
yes
Attached: yes .viol
ling permit may be required by:
Local Planning jurisdiction)
h
_u
.or
Adj. Mr. Body O r i -e tn
Closest Maj. Wtr. Body %d .�'a'''� Oif
v "
ru
(Scale: IV,'
❑ See note on back regarding River Basin

-CoM
NC Division Of coarAal-09t. Habitat IMP. actputer Sheet
To �/� 5 g1/`
Applicant: /14.r
Date: Ct
Describe below the HABITAT disturbances for the application..
. match the name,and units- of measurement found in your Habitat code sheet,
All
values -should
--TOTAL -Sq. Ft.
H" for.
FINAL Sq. Ft.
(Anticipated final
TOTAL Feet
TOTAL
P C-
P 1.4
(A (Applied for.
F11
(Ar
DISTURB TYPE
(Applied
Disturbance.total
includes any
disturbance.
Excludes any
a
Disturbance
5
includes
total includes.
total
dis
Ev
Habitat Name
Choose One
anticipated
restoration
any anticipated
or
res
te n
restoration or
ternp irnpacts ),.
andforternp
lmPa 2MOuat).,
restoration
teMP 100qs-1
'
Dredge Fill 171 Both ❑ Other n
Dredge 171 ' FRIA Both. M Other [I.
I
Dredge 0 Fill EllBoth ❑ Other 171
Dredge ❑ Fill F1 Both E1 Other ❑
Dredge 0 Fill E] Both 171 Other ❑
Dredge, Fill [I. Both 171 Other 0
Dredge El Fill M Both El. other FT

1/08/2016 08:58
BOB & MEG ZAGK
MM
1,'2015 00:22 FAX
Z01)1
ADJACENT RIPARIAN PROPERTY (,OWNER STA)EEMENT
I hereby certify that 1 own property adjacent to
(Name of Property Owner)
property located at 0 C��t
Y/x'0L-'
(Address, Lot,
on C 2lr l� in
(Waterbody)
The applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT �—
(Indtvldual propowing development must tiff In description below or attach a site drawing)
} G � C.. ,a-.-� ram-- � ��j'`'� �v ,�1�. ►�►� (4!
1 T-e nK 11 l7-0 L
C-aw�1
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.
1 do not wish to waive the 15' setback requirement.
'(Pro y OwnqO tntalf�h*tlon) (Ad opsrty Owner Information)
[yam ".S�".�.,
Signature natu /^ /�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to —17✓vag -'� Td tlt � )A-, s
property located at / ,(� \ (Name of Property Owner)
ow� �U �l
r, II((Address,.Lot, Bloc , Road, etc.
on �1� M i9 G i,Y,o� )
i .2��1, N.C.
aterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatson.
x— I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
(� III ��2' A'1%tr�
TGr.
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.
(Propert Owner Infor ation)
Si n re
Pr�or�Tryt3ee.Nalne
(Adjacent
Signature
er Information)
Print or Type Name ,� r