Olephant, Richard

❑i�AMi�/ ❑DREDGE & FILL r ' No. 74493
A B D
GENERAL PERMIT Previous permit#
Clew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality "'J/ � (� c.
and the Coastal Resources Commission in an area of environ ental concern pursuant to 15A NCAC ` j7
1
-, / Cl Rules attached.
Applicant Name l `' ' ' 0 C ) <r' I Project Location: County ( � '-
Address Street Address/ State Road/ Lot #(s)
City `,, I11�i�, State %✓ZIP '�;f `-7 ,',,
Phone # ( ', `. ,) J " Y(' y-Mail Subdivision__-
Authorized Agent City ! r', l- i i ZIP
Affected ❑cw"- ❑EW ❑PTX El ES ❑PTS Phone# ( ) River Basin
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (��' L,t ., r _ )
/ (nat /man /unkn
❑ PWS:
ORW: yes / no PNA yes //6o Closest Maj. Wtc Body - -
Type of Project/ Activity
(Scale: / % )
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore _
max distance offshore i
Basin, channel ,
v
cubic
Boat ramp
Boathouse/
Beach Bulldozing
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
Agent or Applicant Printed Name
Signature **Please­red ompliancestatement onback ofpermit"
i
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
i �11..._�.`=_..-
Signature
Issuing-Dat AxpirationDate

Date of Request:
Property Owner Name:
Address of Property:
ot-c
Telephone Number:
Type of Work:
Hurricane Florence and TS Michael
Replacement/Repair Request Form
- Qw)G-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:
RrrCEIV ED
MAY 10 Z0
pCM-MH® CITY

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