Hodges, Jim & Gwen

❑CAMA / LI DREDGE & FILL NO. 74468
-. A B C D
ENERAL PERMIT Previous permit#
[]eW DModification El Complete Reissue ❑Partij] Reissue Date previous permit issued
As author ed 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 ❑Rules attached.
Applicant Name r i C. i Project Location: County
Address K✓ L : Street Address/ State Road/ Lot # s
i In t t ''v l _1 c._._ ti t Rio I 7
Phone # ( /i)
E-Mail
Subdivision -----'
Authorized Agent
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Phone # 6 ,� J River Basin
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Adj. Wtr. Body ��.�'\ l i �(1 d
El PWS:
C
Closest Mal. Wtr. Body
ORW: yes / no PNA
yes /' no
Type of Project/Activity
(Scale:
Pier
Fixe
Float
Fing
Groff
Bulk
Basis
Boat
Boat
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A building permit may be required
( Note Local Planning Jurisdiction)
Notes/ Special Conditions _
Agent or Applicant Printed Name` `I
Signature '** Pleaseread compliance statement on back fpermit**
Feels)
Issuing
❑ See note on back regarding River Basin rules.
/
1 Namee
/
' Expiration Dat

Hurricane Florence and TS Michael
Replac?ment/Repair Request Form
Date of Request:
Property Owner Name: -S 01 6U-1i5/hi Ably S
Address of Property: 18,5'7 i AL01 a `( I.YtWb 1 IBC
Telephone Number: -7-2 5 'S-2, &
Type of Work: -Doc),-- 791�:M fl? 1,44 5AM1 ✓ -4:�D&WOJ Jr
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
MAY 0 6 Z019
DCM-MHD CITY

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