Beaman, Judy

OCiAMA / ❑ DREDGE & FILL II, ,, l�j 1 ' `; No %SO%% A B C D
NERAL PERMIT � PZ!otispermit#
[]New . ❑Modification []Complete Reissue [-]Partial Reissue Date previojus permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the CoAtal Resources Commission in an area of environmental concern pursuant to 15A NCAC `
]Rules attached.
,
I sa /
Applicant Name j c. CT.{- , 3 ,'z ']. j ,j Project Location: County i'--
eaaroo�
Phone #
Authorized Agent
-
Affected ❑;CW d@W
1-1❑ HHA DES ❑PTS
OEA F., ❑ UBA ❑ N/A
AEC(s):
❑ PWS: /
ORW: yes / no - �) PNA yes / nr-
Street Address/ State Road/ Lot #(s)
Subdivision,
City (6 . Ci ZIP-
Phone # (.. _) River Basin
Adj. Wtr. Body_ _ _. - _. _ _ (nat /man /unkn)
Closest Maj. Wtr. Body
0110MEME:::::6°IMMEME::6::�6■■�
�MOORE
■■■■:::::::6:
■::.�■■::�J
■MEMOS
EE■EME
■■■
ME
MOORE■■■EN
MEN■■
MORE
IMESMEMMMEME■■MEW
6'::::66°
:::
■6666:666R:■:
EN
■E■■
■■■■■■■■.
M
FI,II
■■■■
NEW
■..■■■.
No
■■..■.■..:
ME
►
ME
MEN
0
■■■.
MEN
MEMO
■p
.■.
■E■
■:■■M■
■■M■.■■■■■■■O
O■:
:
M.�WRE■■
■0■
■■MOO■■MME■O■■■O■■■.�■■
�iil�r�n■■■.■:....
M°�i:::°:
:�6°°EE :■M
■O
Ir ■■
6■■ O■■
■O
■EN■■■■■.ON:■
M
M■■
[iJ■■■■■■■■ USES
IN.M:::MME
M.■ ■■■:.■.■■ ■■:° ■■■
■M:■MOME
EMO■rein N■■■■MEN
.�■,■.■■■■:■
::M■■E■:■:::momm:0■■■■■M■E■■■■.::::�:66':::
:■
P
MMOMME�
.■..■ ■... ... .
ORION
Agent or Applicant Printed Name
Signature " Please read compliance statement on backof permit"
Application Feels) Check #

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request:
Property Owner Name:
Address of Property:
Telephone Number:
Type of Work:
sz7 t\JK4n4&, Aue .
k
rLA
V.
2Sz
I
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:
RECFavED
0- 15 Z019
DCM-MHD CITY

t B :2i �J I ?� �n� • S - is 5'.. n
w t.
•
`.� hld • g
ap .`F
441
IDZ
t s
4.0
"
ill ivu I £ $
O M
�s
E
801 ! av
E
J ILI'
At
er
cU
o �5
l D`o
O W d C Pa O
0 LO
p�o
q b C a N u
5byC Px7 b b I
E o a Z Pa Pa z C 5
a Q o
N to N
M U m6
In
r� N M [ N W 7 l� .�i Ili
.+ 00 O N in O LO .. $
M 'xi <R N Q V x � x n N ~ "
J O co y O S�
M tp �' V y V .p 7 F V C.% N y3
'��"
5 59
—00 F 3 ¢o �a
N F `� T