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Home My WebLink AboutBrewer, Curtis & Betsy®n,CAMA / ❑ DREDGE & FILL t ` No. 75227 A B ' C D ENERAL PERMIT Previous permit# I eve ❑Modification ❑Complete Reissue ❑Par4al,fts rfe Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Duality and the Coastal R �ources Commission in an area of environmental concern pursuant to 15A NCAC i;C7 Rules att shed. Applicant Nam t � ` � � �, 'J r I '- � �,; /yam �roject Location: County f i (_ j I% �i' —•° Address ` / ? I Street Address/ State Road Lot #(s) City_ State ZIP I i �•-_. � �� l }� v ( �� ((f � ( 3-: � � Phone # O�-.. ,. _�E-Mail Authorized `ryA��gent qgW 4P7A El ES ❑PTS Affected AEC(s): TCW LJ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes /� PNA yes /(no ,) Phone # Adj. Wtr. Body %.' Closest Maj. Wtr. Body k(lj/ ZIP Basin f.j .�.�'1 d �.l ' LY . ■Mia�C■w■■■■aM■■■■w■!E■■�■ ■■■■■■■■ ■■ ■■■■E■■ME■■■■■■! ■!■■■■■■■ ■E!1® C■■u■ !■■■ITEM MMM■■�M■■■■■ ■ ■ ■■■■�■■!■ ■■ SEEM ■■S■■■E■■■■M■■■■■■■■■■■E■■w■■■■0■■■■■■■ ■■■■■■■■■■■■■■■ ■■■E ■OM■■■■ ■®■ ■■!■■■mME)E■ Wi 'HOME MEmu ■■■■■ SOMEONE ■Ei®rl■,ll®il 01111101111100111101111111 M■■ME■■SEEM i��■fJ■■■S■ i■SOME om�ierr1MEMii■■MSSr■ce■■�■■■■!■■■■■ • ■■■!■■■!■■v■■■■■■■■■E■■■■■■■■■■Mrs■■ 0 ■o■■■■■■■■Ew■■M■■r■ C::::::nEmommumm ■■■■EN INMEus■■i UNIONS! WIN CC�CC S ■■■■■E■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■.■ C■■E■ES■■ ■■■■■■■■�C®MESS■■■. ■■■■■■■NI MENEM INE:::��::� w■■......E■■■S■■■E■■■■■■■■■■■■l■■E■■■■.. :::® :SC�WAMEME IMMEMIN :::::�� Agent or Applicant Printed Name l Signature "Please read compliance statement on �ackof er it'µ'i' Application Feels) Check# Hurricane Florence and TS Michael Replacement/Repair Request Form Date of Request: Property Owner Name: Address of Property: Telephone Number: Type of Work: 9/9- <�?90 - 0�� 2 & 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: RECEIVED JUL 19 Z019 DCM-MHD CITY I hereby certify that I own property adjacent to /<775 4- �k-7: 0 f!( 's tNameJ�f Pro Owner) property located at /yf�� (Address, Lot Block, Ro� �jj•etc.) on �D4dE Sodyl� n N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locate 4C e�-<O-C I have no objection to this proposal. ___ I have_objeetions to_this_proposaL DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) %5 ?( ?4/01 Aker! 41, hvd khsAd *aiP Ate, ZOC* is /�v�X3a�oCE 14, 1111111111 1 4 Ko� -/-`' &C.4A£ U bvlhld WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by m'i9byLQi11ED wish to waive the setback, you must initial the appropriate blank below.) QC.. I do wish to waive the 15' setback requirement. AUG O 6 2019 I do not wish to waive the 15' setback requirement. DCM-MHD CITY (Pro rt caner Information) Si atu e /�l s oy' me ge 144,iRy1g / Date (Adjacent Property Owner for tion) Signat�rrre. s��t rtn (J! lQt,�l`S!� L� pe Name Mai{iy�q��----(D City/Statellip Telephone Nu er Date (Revised 611812012)