Gottschelle, Ted

DREDGE & FILL NO. 73953
A B �C D
-. GENERAL PERMIT Previous permit#
E*ew []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.
t i i ! (n f< !z' Project Location: County
Applicant Name_ ) -
Address j `✓ i / ' �' bo " l { Street Address/ State R1oad/ Lot #//(s)
City State ZIP a^
Phone # (_ _)_ / �f� l ! E-Mail Subdivision --
Authorized Agent City ZIP
[ltw
Affected ❑ OEA
AEC(s):
❑ PWS:
[SEW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
ORW: yes / no PNA �' yes / no
Type of Project/ Activity
Pier (dock) lei
Fixed Platforn
Floating Platfc
Finger pier(s)
Groin length
number
Bulkhead/ Rip
avg disv
max disc
Basin, channe
cubic ya
Boat ramp _
Boathouse/ B
Beach Bulldo
Other
Shoreline Lei
SAV:
Moratorium:
Photos:
Waiver Attar
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed' Natlner
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Phone # ( ) River Basin
Adj. Wtr. Body ` ' % (fiat %maw n /unkn)
Closest Maj. Wtr. Body
(Scale:/ / )
Permit Officer's Printed Name
Signature
Issuing Date Expiration Date

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

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request:
Property Owner Name: I Lf`<D Co Gby��� C��J f L lSlpM D p�
Address of Property: � aLo 02 V� � G (Y 3 �� A�D-
Telephone Number: �5�� - 3 (4 2 ^1�6 3 a (
Type of Work: s...,' k-N�y ¢- ba 6e- �&& per lL
NOTE:
• The Emergency CAMA General Permit 2500 is for repairs and replacement of water -
dependent structures damaged because of Hurricane Florence and/or TS Michael. The
replacement, reconstruction and maintenance excavation activities shall conform to
current standards and rules. All work under the Emergency CAMA GP 2500 must be
made in the same footprint of the previous structure with no additions, expansions, or
enlargements.
If any portion of a structure being replaced is within the 15' setback of the riparian line or
access area, signatures of the adjacent riparian property owner(s) must be obtained
a o-owledgin.g the notification..:and waiver of the setback on the forms provided by
DCM.
• Any maintenance excavation or dredging requires signatures of the adjacent riparian
property owner(s) on the notification forms provided by DCM.
Signature:
RECEIVED
FLt;Z
DCM-MHD CITY

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