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Hickory Shores HOA
�CAMA / ❑ A B C D DREDGE &FILL �. ,� 1 J �. 1 � aN0. %SO 16 ® l ENERAL PERMIT Previous permit# ew ❑Modification ❑Complete Reissue Fs?irtial Reissue Date previous Permit issued As authori ed by the State of North Carolina, Department o Environmental Quality I and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f ❑ Rules attached. , Applicant Name Project Location: County Address Street Address/ State Road/ Lot #(s) City��I- -� ('t_ ) State _ZIP ) /, �l/ Phone #((t j " : / f' E-Mail Subdivision Authorized Agent City 1' ( L•l - /( ZIP, w I ❑w PTA \ES ❑ PTS Phone # River Basin 4e Affected El OEA 'HHF H ❑ UBA ❑ N/A AEC(s): Adj. Wtr. Body l (- nat man unkn ❑ PWS: ' ' ORW: yes / no PNA ;yes / no Closest Maj. Wr„ R_ �.' ( ! � � t/—, 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 Boat ramp Boathouse/ Beach Other Shoreline Length $AV: not sure yes rfc Moratorium: n/a yes no Photos: yes ;no Waiver Attached: yes ;Poo A building permit may be required by: _ ( Note Local Planning Jurisdiction) 1 Notes/ Special Conditions Agent or Applicant Printed Name (Scale: .- ) 'y / i , ❑ See note on back regarding River Basin rules. Signature "Please read compliance statement on back of permit" t, Signature Issuing Date - Expiration Dad Application Fee(s) Check # Hurricang Florence and TS Michael Replacement/Repair Request Form Date of Request: /y i I Property Owner Name: Address of Property: Telephone Number: Type of Work: NOTE: 6-4 [A pia 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: RECOVED JUN 21 2019 DCM-MHD CITY ,.. . <\ § \ J I! \ ) \ E » / §! o ^* 0 4-1/ \ $i Q /� §8 /] / 4 " © � /| \ ° / \ § ( / m I - " k ' B gr Cl) k �) a k/)) p // _ ) G mm` o 5 § o 0 E d\ 2 2 2\) k G A} m /!� § ) 3 ) ] \ /k J \ \ \ §\ } [ \ ] w j/ § G B 2= d ; m m 2 § k ƒ 2 f E ) e ®/ ` ) R ] Eƒ \$ Q 2 3 S; {•\ k i E`. � � ° § • � ° � t ` ° d t � © 2 2 t 2 ■ / ■ i /{ } &0x *\/ q= A/ w w»