Westlake, Carol

42k�7
DREDGE & FILL `r < No. 73947 AB D
NERAL PERMIT Previous permit #
,ry -Modification Complete Reissue _Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r c; U
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC D Rules attached.
Applicant Name _ I C" Project Location: County_ '—y
-.
/ Street Address/ State Road/ Lot #(s)
Address
City
State ZIP_ J —_
Phone # (_ _ )_ _ E-Mail Subdivision
Authorized Agent City ZIP
CW [IEW []PTA [I ES ❑ PTS Phone # ( ) _ River Basin
Affected OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body __ _ __ - _ __ _— fat /man /unkn)
PWS:
Closest Maj. Wtr. Body --- - -- -
nRW vp� / nn PNA ves / no
Type of Project/ Activity
(Scale: f✓ )
Pier (dock) length
!
I
Fixed Platform(s)
I
j
Floating Platform(s) _
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
i
I
�
Basin, channel
i
cubic yards
Boat
ramp
Boathouse/ Boatlift
I
t
-
-
--
—
Beach Bulldozing
!
I
i
-
Other_
Shoreline Length
SAV: not sure yes no
i
! I
Moratorium: n/a yes no
Photos: yes no
— —
I I
Waiver Attached: yes no
A building permit may be required by:
!
f /
f See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Printed Name /
V
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/ I-888-4RCOAST
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:/ I
Property Owner Name:
STL/tK� /�10
M'mx-
Address of Property: 3 70 Z IMF RA1_p _�)gI V �- } FA4F-g q LD /SLE .
Telephone Number: (2 / 5- `{a o - ,7 `% 0 3
Type of Work:
CUNT) aowr)
NI S
0
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
- acknowledging 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: C 11
MAIq�4kFT
W �-S i l_RKE_

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AGENT AUTHORIZATION FOR CAMA PERMIT. APPLICATION
Name of Property Owner Requesting Permit: IQAW AAi2-2� WS-sTzA/ce-
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
ffg 7 iposT P'L 17 .
All, SMVIL L-,-- %N 3'72o--f-
is (S- yaa '7qc 3
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: {esAore w i e-r
at my property located at 3 �76 Z PrvkUL--,L-" 5 1) ��w�zxzft--1 (s'-L ,klc
in County.
1 furthermore certify that 1 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:
Aj
Signature
AAVe6,a 2-iF--� W W E-S TLA-K �
Print or Type Name
Title
l_I 0
Date
-� This certification is valid through , / I

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