Byrum, Dan

ECAMA / LL DREDGE & FILL L Q N( 75037 A B (.C) D
GENERAL PERMIT 11 r _viouspermit#
ew ❑Modification []Complete Reissue ❑Partial Reissue -rate 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 / j
ules attached.
Applicant Name ' If .__ Project Location: County
Address,
City ; State ZIP
/.j
Phone # (' ) E-Mail
Authorized Agent
Affected ❑CW L3 EW A ❑ES ❑PTS
: �OEA ❑HHF IH ❑UBA ❑N/A
AEC(te
❑ PWS:
ORW: yes / no PNA yes /
Type of Project/ Activity
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel T
cubic yards
Boat ramp
Boathouse/ Boatlift�
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes 'Fof
Photos: yes ��
Waiver Attached: / del no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
i
Agent or Applicant Printed Name
Signature *Please read compliance statement on back of permit"
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s)
Subdivision_
City_ _ ZIP_
Phone # ( ) �'<, L'�(,_�River Basin
Adj. Wtr. Body "-� (nat /man /unkn)
Closest Maj. Wtr. Body _-
(Scale: __ )
❑ See note on back regarding River Basin rules.
i
PermitOfficer's Printed Name'
Signature
Issuin D to Expirati n Date

Hurricane Florence and TS Michael
Replacement/Repair Reques, Form,
Date of Request: C
Property Owner Name:
Address of Property:
Telephone Number: - t 191 lou k
Type of Work:
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: ct� ^v
RECEIVED
JUL 0 9 2019
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT t✓Z90
I hereby certify that I own property adjacent to ` l�kf�l �I— �✓ m -s
property located at
on 8Z%0E ing6D Grt`f N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Nef9� (�$ Djtp GcEo
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RECEIVED
JUL 17 Duly
DCM-MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
/ 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adj"t Property Owner Information)
a
cltyi�ta�e�ip .i 43 — D 4 $
TeI hone Number
Dare
S 9
(Revised 611812012)