Alcoke, Kimberly J.

i
®❑ CAMA / ❑ DREDGE & FILL i, I•` j
GENERAL PERMIT Previous permit#
dZew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorYed by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
/I,,'- J Rules attached.
Applicant Name C, 'Project Location: County
Address " Street Address/ State Road/ Lot #(s)
City tate ZIP )
' r
Phone # (�) � /T _il Subdivision _
Authorized Agent .. - City _- _ ZIP
Affected EJCW L7EW ❑PTA El ES ❑PTS Phone# (,.. ) River Basin_
AEC(s): OEA ❑ HHF ❑///IH ❑ UBA El WA Adj. Wtr. Body _ - - ._(oat /man /unkn)
ElPWS:: �....
ORW: yes / no PNA yes / no Closest Mal. Wtr. Body —
Type of Project/ Activity
_....- (Scale:
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Mprap length_
avg distance offshore
max distance offshon
Basin, channel
cubic
Boat ramp -
Boathouse/
Beach
Other
Shoreline Length
SAV: notsure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: ;yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions T
Agent or Applicant Printed Name
Signature "Please read compliance statementon back of ermit *'*
i
Application Fee(s) Check#`
❑ See note on back regarding River Basin rules.
Permit Officer's Printed
Si nature
Iss ing Date I I Expiration Date

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request: V � I ) �I
Property Owner Name: K/ f� 6 (t I C
Address of Property:
Telephone Number:
Type of Work:
A/C
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 31 2019
DCM-MHD CITY

I hereby certify that I own property adjaLcent to v t 1 CU7" 's
1 1 � r,,,2rame f Property Owner)
property located at d� 6II
(Address, Lot, I c�, Roa� �, etc.
on in Q I /Ae I` 'A C , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
L4to
l have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
ACA d
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
"_ 3 1. M 9
(Property Owner Informatioq) (Adjacent Property Owner Informati' r RD CjT't
r
or
Date
N
Telephone Number/� mail address
_7 - ;? l7
Date"
(Revised Aug. 2014)
*Valid for one calendar year after signature'
i

)y certify that I own
tylocated at
(Waterbody)
adjacent to
(Address,
. in
etc.)
700 ke— s
Owner)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
I atio
/1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or Hach a site drawing)
�'� q—,Cw
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
[date
I do wish to waive the 15' setback requirement. 'VE
I do not wish to waive the 15' setback requirement. ,' 3 l 2 I9
(Adjacent Property Oviner Informatt0/1)j1,j; D CITY
ifiQ.0
Sign ure
ZACi /Y!
iro�l o ! Tgo
NyfiTe
5-r1Z —&
I Mailing Address • ''J
A%�.aN%rG �E�4GN NG Z$d-7
a City/State/Zip
'Valid for one calendar year after signature`
Telephone Number/email address
7 9 5-- 11F
Date"
(Revised Aug. 2014)

am
33
0
t7
2
v-
a
et
ti
�o
s
�
W
OD
W
N
�cm
$
�H
N
N
to
?
O$
c
�+
�
�
�
�
to
crap
R
�
p
R
[ •
�
��yyy
y
�
�
y
�
�
�{
�
�
�
�
�
�
�
C,•�a
ro
�•
ttl
A
w
Nrn
`fir°
too
o
g
d
fD
v,,
C
'
Uj
x
P.
g
cn
8
az�.R
as
N
N jy
O
O
W
CO
hq
:•:
yy
rf
O
•p
•+
O
r
N
g
0
°
T
°
os
�5
A�
�
�
Z
�
z
�n
o
O
8
8�
3
a
N
�
8&
r
��
�g
$ff
0
`
P
,.
�A
m�
a8
oY
ry•1
.�
Fps
C
w
ort
• N
I
O
£�
N
0
N rt
A
•-
H
A
N
v�
�y
Ctl
N
Ul
O t
A
x
O
° C.
°
�
b
w
\ 1
t
7
co