Burnette, Ronnie

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AAMA / ❑DREDGE & FILL�� �� � �J 1Uk-t/ (`LNo. 75044A B C D
ENERAL PERMIT Previous permit# ❑Modification ❑Complete Reissue ❑ Partial Reissue Date previ us permit issued
As auted b the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environme t concern pursuant to I SA NCAC �� �/
I ules attac e
F d.
Applicant Name I A )1i l > Project Location: County
Address Street Addrss/ State Road/ Lgj�t #(s) r,
City' State n % 1p � .'
P`(/
Subdivision >"
hone#I( `! )�� -Mail / -
Authorized Agent city i (� _� ,� ZIP
AffectedEl CW DEW ❑PTA .I=yES ❑PTS
A
Affecte LJ OEA ElHHF C IH BA El NIA
❑ PWS:
ORW: yes / no PNA yes /.. no
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s) _
Floating Platform(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshc
max distance offsh
Basin, channel
Boat ramp
Boathouse/
Beach
Other
r
Shoreline Length
SAM notsure yes no
Moratorium: n/a yes no
Photos: yes o
Waiver Attached: yes not
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions _
Adj. Wtr. Body' _ _ __ (nat /man unkn)
Closest Maj. Wtr. Body_
(Scale:..---- )
❑ See note on back regarding River Basin rules.
Agent [or,//bA.'(7p1ita rimed Name Permit Officer's Printed Name
Signat/turreeff~"1 Please read compliance statement on back of permit . Signatur
Application Fee(s) / �" Check - Issuin Da e

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request:
Property Owner Name: K4,afl,i
Address of Property:
Telephone Number:
Type of Work:
NOTE:
1/9-2/n-87,2b
• 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:

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