Wade, JB

❑CAMA / ❑ DREDGE & FILL / ( ! ' '� No. 75235
A B CC D
GENERAL PERMIT Previous permit#
❑ fin New ❑Modification ❑Complete Reissue []Partial Reissue Date previous r it issuee-d
As authorized by the State of North Carolina, Department of Environmental Quality j// \ C�
and the Coastal Resources Commission in an area of environmental coricern pursuant to I SA NCAC )
// ❑Rules attached.
Applicant Name f`-! - "{' Project Location: County < �'- -
Uty r r' f
Phone # O �� ,
Authorized Agent_
Affected O Cw
AEC(s): ❑ OEA
❑ PWS:
o ORW: yes ( no )
State,",)". ZIP
{SEW El PTA ❑ES ❑PTS
❑HHF ❑IH ❑USA El N/A
PNA yes Prho J
Street Address/ State Road/ Lot #(s) /
Subdivision
City i ZIP J
Phone # O( River Basin
Adj. Wtr. Body 1 t '�C t`'„y'^ ' r (nat /man /unkn)
Closest Maj. Wtr. Body
■u■C■m■■■■■■■■■■■C■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■
■■
■■■■■■■■■
ME
ME
-
u■CCr■iiiiiiiiiiiiiiC■iiiiiiiiiiiiiC■C
■■■■■■rrr■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■
■�■■■a■■■■■■■■■■re
CdCCCCnCCCC■i■CCC■■CCCNCCCCCCCCCCCCCin■■■■■v■■■■■■■■■■■■■■CC
M.
CCCCCCi,� �CCCCCCCC�CCCCCYlNC�®CCCCC
CCC.....■........■.■�........■.�....000C
• ■■■■■■1�■■■!�®■■�1■■■N ■■ ■■■■■■■■■■■■■■■
'CCCCCCCCCCCCCCCCCCCC CCCCCCCCMEMEMEME
C.....■...............■■■■■■■■■■■■■■■■■■
CCC........
C�CCCCCC� CCCCCCCCCCCC ■■■■■■■■C®CMEN
.C�CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCI
r
Agent or Applicant Printed
Signa/!tyyrree'::'* Please read compliance statement on back of permit'i's'
" �
Application Fee(s) Check #
PermitOtfcer's Printed Name
Signature f�
/
Issuing Date' ( Expiration ate /

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request: —7 a-7119
Property Owner Name: a -e-
Address of Property: �2� �� �� , C'4' i a% /4G
Telephone Number:
Type of Work: (-e6v t16 ipi eta"
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.
Si ature:
RECEIVED
AUG 0 9 2019
DCM-MHD CITY

AGENT AUTHORIZATION FOR CAMA PERMIT: APPLICATION
Name of Property Owner Requesting Permit: �� e
Mailing Address: �� �Ui �w . Dr,
n
K N� agsv►
Phone Number:
Email Address:
I certify that I have authorized
"9S
caw►mil acey'
�i
Agent
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed -development: I � CeJO4- I oI"Lr �w�
Rt'n
a
at my propertylocated at I ��. � a r- Co �v��cled e ;eta
in ( `rri —el County.
1 furthermore certify that l 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:
Signature
Print or Type Name RECEIVED
T3 CA)A-ae
Title AUG 0 9 Z019
4-71 `DCM-MHD CITY
Date
awl l
This certification is valid through /
?/. Z-7 2— (

C a r t e r
e t C o u n t y, N.
C `
�
I3A
is
// ,a+
.. if � {
�,♦
B " \.
s�•
f 4
• ♦
% {t
23sI6
n.
'
/
re:
15
+.
I
/r
� f✓
AF"
l Y
s R
/
\.\`..
3207
Aw
` q
August 13,2019
Th a in lwmabon Mal Wed by hswoWW is ppdelbr I M IMMWW of ral Pab"fond phi inN is lwWiNM nE Ism naibElmm mcm&ddWM.pm. and at or WtlICICSLe mEEN. NHn of MIS lMo:metlm re eseby seated and ft tlaer,ntltled pblc pimry inlVSannmAon
ces sIwJEEe-1.f.IOMM,.l. as. irla:mEM.M19e. an..S., Ceerd Msi,eswmes noleyd respr&dllyW IM Ffomiaanea.l.c.nlHeslb. CaknlCwrry danteBuvnMa tla1NaMs.M nap wrvcesed be ntil�leb uaxswlle.t.,
a. Futlie:m m.CabmlCarly naymWNw mp serve saM xceW lreWhtlwlll.