Paden, David

Cl CAMA / ❑ DREDGE & FILL /-- �No• 75772
.. A B C D
GENERAL PERMIT Previous permit#
❑'New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Rnvi'rcnmental Quality
and the Coastal Resources Commis ion in an area of environmental concern pursuant to 15A NCAC
P Ryles attached.
Applicant Name 1 ;i ' , J Project Location: County +- A:, l _
Address 1 ' Street Address/ State Ro / Lot #(s)
City State / ! .ZIP % �� i' -�
Phone # ( ) �E!Mjai Subdivision.;
Authorized Agent _ City_
Affected ❑Cw Q,,eW XkA ' Es ❑PTS Phone# ( >`') River Basin '.
❑OEA ❑NHF ❑ H r�❑�ZBA El N/A II
AEC(s): Adj. Wtr. Body 1 (' nat ma
❑ PWS:
.
ORW: yes / no PNA yes / no Closest MalWtc Body, -
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Agent or Applicant Printed Name
PermitOfficer's Printed Name,'
Signature ** Pleaseread compliance statement on backof permit'*
Application Fee(s) Check #
Issuing Dated-F Expiration Date

Hurricane Florence and TS Michael -k DOT16
Replacement/Repair Request Form
Date of Request:
Property Owner Name:
Address of Property:
Telephone Number:
Type of Work:
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 CAM 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:

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