Privette, Julie

®9^ INCAMA / ❑ DREDGE & FILL ` ` ' {`--NO. 75715 A B C D
ENERAL PERMIT Previous permit#
New ❑Modification []Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality !� 1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
LJ R
\ ules attached.
Applicant Narne: L i� : '', i V [ 1711C Project Location: County LC •�
City—L
Phone #
Authorized Agent
kcW
NEW
IAPTA
DES ❑PTS
Affected
/❑11H
AEC(s): �OEA
❑HHF
❑UBA El NIA
❑ PWS:
ORW: yes / �o
PNA
yes /
o
Street Address/ State Road/ Lot #(s)
Subdivision
i
City ziP'.
Phone # ()l ) lA" . fiver Basin ( t
Adj. Wtr. Body I u, P i 1 (1 I (fiat /man /unkn)
Closest Maj. Wtr. Body `i Imo:''
MEN■■■■■
OEM ■■■■■■■■■■■■■■■
■■■SEEM■SEEM
QiMEMMENiINsiiiiMENw■
ww■ni�■ii'n■i�iiiiE
■■E■JUMMMEME■■■■E!EM11111
'■Eli■■E■iE'�■■■E■■■■■■E
■ME■E■■■NE■S■■MENE■■■
■M■■!■Il
NE■■■■■■■i
■M■■EN■BI■E■ICE■■S[[im
111■1�E■!/■l4■■■■WAN
SEES■
■
Sam
�■SEE■
����tE�li�0
1E■■M■f1ENI�■■E
E■nlh�ln►�1■■EJ11E■�
■RON
EWES■
■E■■MEEN
■E■
Now
■E■■■■E■■■E■■
MEN
S►MEN
SEESEMS■E■■E■■■
NEE
■VIEEEE■EMEW',■■■►/A■■■SEEN
EN■ENIHMm
N■i1■RM9111
■S■E
AM
■■■E
■M■MEMEMN
■ESN!■
SEE
EEEE■■■■■■■SEE■WA■■MEN
■ENE■ENE■�■■C.!■
mom
■�NEE�N■■■■■■�E■■MEN
ON
iiiiiiiii�■i�ME�iMEN�s■ii�iriiir
■E
MENNINEE IS MEN
MEN E Mimi
M. INN
■■■ ■■■........■■
I
■■E■■■■■■■.. ..■.
■.®C■.�....C.:��......■�■.■
.C.
■■■■.■■■■N■■■■■■mom
..... .
SEE■■■■■E■■■■N■■■■■■■
• ■....■■...■�■■■■E�■SMEN
■■■■■■■■■■■ .■.■■ S■
OEM ■.■■■■■.■..■.
MEN ■OEM ■.■■EE■■■1■.■■
.■.■so .■■
■■■ OEM ■■■.■.■■■■SEE■■SEE
SEE IMME■■■■■E■■■■SEE■■■■■
■■■ NONE ■■■■■■■■M■SEE■■SME■■■■MM■■■■■■■
i■iiiCiiiiCii■EE■i'�iiiii'�Ciiiii■iiiiiiii
■■N■■E■�■■■
MEMENEEN
111111 ME
ii:E ONE 0 i11 NEE
®�N
a�iiC�iia�i�iii
Agent or Applicant P inted Name.,
Signature Please read compliance statement on back of permit *'*
Application Fee(s) Check#
PermitO ficer's Printed Name
Signatpre _
Issuing ate T %'t�Expiration Dgite/ %�

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request: 1 — CO I q
Property Owner Name: —ryll
Address of Property:
Telephone Number:
Type of Work:
a5--�Z-5-al - f6lCp0
r,
frRs' ov'"r anr� re�fAc�e oc ar i
54Me
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:
1N\9�Ia,
qo� %
aSC,0vf-D
SV 10 2019
DCM'MND CITY