Sigman, Dale

AMA / ❑ DREDGE & FILL �'—/ P i� -r No. 74939
A B lC., _ D
i =NERAL PERMIT Previous permit#
1 ,eW ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commissiop in an area of environmental concern pursuant to I SA NCAC
11 ❑j�ulesattached.
Applicant Name ;/' ` ' Project Location: County (_, / .` n / r'.
.'I.1
Addressf I J i Street Address/ State Road/ Lot #(s)
City State .J zip
Phone # () / } �' ,t (�j E-Mail
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Authorized Agent
Affected ElCW ElEW ❑ P"TA' ❑ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no .
Subdivision
City C ZIP
Phone # ( ) River Basin % �^
Adj. Wtr. Body dl�t man unkn
Closest Mal. Wtr. Body�� /
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Agent or Applicant Printed Name
** Please read compliance statement on back of permit *"
Application Fee(s) Check #
,l.
PermitO ficer's Printed Name '
Signature
IssuingD te�/Expirato�/Expirato

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request: 6 v 1 I
Property Owner Name:
Address of Property:
Telephone Number: M -
Type of Work: IlY nC N— ���V �C�� I 11l,T'
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: 1//0 No ,t n
RECEIVED
MAY 0 8 2019
DCM-MHD CITY

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