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Home My WebLink AboutBruni, BrendaJCAMA / ❑ DREDGE & FILL ' NO. 75220 -.�- A B C,. C D GENERAL PERMIT Previous permit# Phew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality �1 l/ t( and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC J 1 I `-' �("� ❑R es attached. Applicant Name 1I / ^ : ( ! /�^' Project Location: County city ' Phone #(' ) Authorized Agent Affected ❑ cW AEC(s): 17 OEA ❑ PWS ,.0 State ZIP i- t J )✓" E]EW I1 PTA El ES ❑PTS ❑HHF FAH ❑UBA ❑N/A ORW: yes / no PNA yes / no Street Address/ State Road/ Lot #(s) Subdivision _ City �Nl ("Y ' ' fJ ` ZIP Phone # O River Basin ,f Adj. Wtr. Body > ). (nat /man /unkn) Closest Maj. Wtr. Body - ■N ■ ....... ..■... ■■■■■ 1::::MM:I:::.;::::::::No .■■. ■ .. MMMM ■■■■■■■■■■■■N■■ m...■■■■.■■■..■.■ ■■■■ NM■y��■■III ai■� ■�� ■ii■ i si �r■i� MENEM M No Sol No OEM ■ii ■ :ii MENEM IIIIii�ii iNiii�r :�::C■� NOME :�■E ®::: :e @: ■N■■■N■lm■ m■■■■s■■N■■.■�■■ ■■■ ■o■■o■■■■I■■■�■■■■ ■N■■■■■�■�■■■N■■■�f/.■o■■ i■N■iiiir■iG��■ME��ii ■N■ • ■■■■■■■■■Y ■N■■■■�■I■■�■N■■■■■■■■■■■■s�■Cs■■■o smsmuomri :::::::::C:::::■:": C...... ■/I■■I ■■■■ ■■■�®�■� ME C:��::C:NO ■■N ■■■■ s■■■■■o■■■■■N No:��' ■■■■N■■■MM MN■ ■ ■ ■■ ■■ ■■■■■ ■■ ■■ ■moss■ ■■ ■■ C:':: OEM ■...C■■■..�.. Agent or Applicant Printed Name Signatuf /+ Please read compliance statement on back of permit'r* Application Fee(s) heck # AMA / ❑ DREDGE & FILL Ay-+�e4 No. 75220 .. A B C D GENERAL PERMIT Previous permit# ew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality Ll�'i`Y,/i and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / y�� I /J�� ❑ R1�es attache . Applicant Name 1. (i-U'� t✓i✓^ Project Location: County CS/ Address Phone # Authorized Agent 661 I/"- Street Address/ State Road/ Lo #(s) 1� .S 712 P ��.� , ns Affected ,�q,��(• 'SEW Rr'A El ES ❑PTS AEC(s): `l - A 71HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA yes / no Type of Project/ Activity Pier (dock) lengtf Fixed Floati Finge Groin Bulk Basin Boat Boat Beac Othe Shore SAV: Mora Phot Waiv Subdivisio Phone# (_) River Basin /tom Adj. Wtr. Body � an unkh Closest Maj. Wtr. Body (Scale: ) Platform(s) ng Platform(s) head/ i r pier(s) length number Riprap length avg distance offshore -- 1 -- - (- max distance offshore I ,channel � ___ � �__ _ - -- -- --,, i _-__ cubic yards ramp house/ Boatlift � — _ . _ — - - h Bulldozing r line Length not sure yes no torium: n/a yes no os. yes no A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions Agent or Applicant Sign \Please read compliance statement on back of permit" A ;cation ee(s) heck# ❑ See note on back regarding River Basin rules. ri Date Hurricane Florence and TS Michael Replacement/Repair Request Form Date of Request: Cl _.1 Property Owner Name: Address of Property: Telephone Number: Type of Work: NOTE: Y ,9w, 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: ��n dC ) Gc \An l �-)C)LA D'C VteCe\VET AUG 03 2p19 CCM,MHD C�S�