Sanchez, Denise

_ CAMA / DREDGE & FILL `) a. e t \
❑ ❑ t !' I (`-!No. 75773
® A B C D
C.�ENERAL PERMIT Previous permit # .-
q�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 I SA NCAC
_l p (tuloa=bed
Applicant Name_' Project Location: County ( i- C C_.Z
\ /
Address
f. StreetAddress/ State Road/ Lot #(s)
City_ _ - State ZIP Y -
Phone # ( )- E-Mail
Authorized Agent
Affected CW ❑ EW C PTA ❑ ES ❑ PTS
AEC(s): ElOEA ❑ HHF ❑ IH ❑ UBA El N/A
❑ PWS: , i
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure
y no
Moratorium: n/a
yes no
Photos:
yes no
Waiver Attached: - -yes
no
Subdivision_ _
City ZIP_
Phone # (_ ) Rivel`- Basil
Adj. Wtr. Body _ ' _ _. (�'' _(nat./man /unkn)
Closest Maj. Wtr. Body
A building permit may be required by;,_..
( Note Local Planning Jurisdiction). _..,._.._--------
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale: "" )
❑ See note on back regarding River Basin rules.
Signature * Please read compliance statement on back of permit'`" Signature
Application Fee(s) Check# Issuing Date
i Date

Hurricane Florence and TS Michael
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 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 rrparian 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:
RFCE/vj�J)
SFP 2 6 ?019
DcM MNo clry

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