Vickers, Jack

❑LAMA / ❑ yREDGE & FILL NO. 74421 A B : C D
GENERAL PERMIT Previous permit#
I❑New ❑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 Commission in an area of environmental concern pursuant to 15A NCAC
� El Rules attached.
Applicant Name r Project Location: County -
Address - Street Address/ State Road/ Lot #(s)
City— — Stater ZIP
Phone # ( )- E-Mail
Authorized Agent _
Affected U CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PNA yes / no
Subdivision
City ZIP
Phone # ( ) River Basin _
Adj. Wtr. Body_ ( Pat//man _/unkn)
Closest Maj. Wtr. 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 o((shore
max distance offshore.
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatli(t
Beach Bulldozing
Other_
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
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See note
on
back
---
regarding
River
Basin
rules.
Agent or Applicant Printed Name
_ s
Signature ** Please read compliance statement on backof permit"
Permit Officer's Printed Name
Application Fee(s) Check #
Issumg Date Expiration'bate

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MA / ❑DREDGE &FILL U IrP/lC\ NO. 74421
�1y A B ��
NERAL PERMITS Previous permit#
w ❑Modification ❑Complete Reissue ❑Partial Reissue �\�� Date previous perrr/it issued
As authorized by the State of North Carolina, Department of Environmental Quality 7(,(J
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
—Teo j / ❑ ules attached.
Applicant Name C(Ic v f C��'e5/ ���"" Project Location: County (f CY Address r cC/rt� ttc I td� Street Address/ State
�R%ad/ Lot #(s)
City V� Statew ZIPay� > �U I'fGflhG� C�
Phone # ry E_Mail Subdivisio
Authorized Agent City V I ZIP
AffectedA ❑ES PTS Phone # ( ) River Basin
AEC(s): � ❑❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body L ) v t"/L✓ man unkn
�❑> PWS: ��
ORW: v/ es /Jno PNA ves/ no f Closest Maj. Wtr. Body (_ V� G cww,i'
Type of Project/ Activity
(Scale: )
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Piprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
i
Beach Bulldozing
Other
i
Shoreline Length
SAV: not sure yes no
*-
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
--- —
----
A building permit may be required by: C�❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction) �) / /
Notes/ Speci I Conditions ,/ " G G� �Cc/G'G Feolelz / r1/Y` /o✓I �/
G C/7 v i1a✓
Agent or Applicant
Signature �**Please read compliance statement on back of permit'r
Application Fee(s) Check #
Name
trf

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request: 44, 14, - / 7
Property Owner Name: s )A e4 < F-2i t L K' r S
Address of Property:
Telephone Number: '5 o q 8 2 7 9-z d S
Type of Work: —✓' �'4 �L' , �L S ' J, I f
J'.� /V(-Z-
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: , /
REC61V ED
APR 16 Z019
DCM-MHD CITY

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