42885D - Tompkins

CAMA/ DREDGE & FILL ,
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3ENERAL PERMIT Previous permit#
New Modification Complete Reissue Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7,4', /ZQV
Giles attached.
it Name aqh 1--p pkj +1'S Project Location: County �rpiPV
201 NN1 �NliA{w, 6+, Street Address/State Road/Lot#(s)
irt+pgfi—ekd State At ziplow3 fir,
E (qlo) 4?V-9ceC Fax#( ) Subdivision
:ed Agent AAd alit€rt- City ZIP
❑CW C3'EW A ❑ES C PTS Phone# ( ) • River Basin
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body /4/4) (natd
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y s!' no PNA no Crit.Hab. �/ no Closest Maj.Wtr. Body �f��
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ax distance offshore_ '7'
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hannel 4, 38` 1
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ie Length /21> '
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lium: n/a yes j
yes 40
Attached: yes /2 D'
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ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:J )w r,} -1T,,y, , s
Address of Property: L-C 161l41 ' C ,
(Lot or Street#, Street or Road)
1 ad JC z418 C ep
(City and County)
I hereby certify that I own property adjacent to the.above-referenced..property. The indiv
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing,with dimensions, should be provided with this lett
1/ 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, NC 28405 or call 910-395-
within 10 days of receipt of this notice. No response is considered the same as no object
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat Iift mu
set bck a minimum distance of 15' from my area of riparian access-unless waived by in
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.
Sign Name Date
r , AV A