Warn, Walter E.

LAMA / ❑DREDGE &FILL'('No. 74931
�l A B C D
GENERAL PERMIT(.(Bweviouspermit #
%lew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authoriZO by the State of North Carolina, Department of EnCironmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
'I GRules attached.
Applicant Name i , V / % t/ Project Location: County --
Phone #
Authorized Agent
4
DtW E4I TA DES
Affected +/OW
A
Affecte ElOEA
ElHHF ❑ IH ❑ UBA
o PWs:
ORW: lyes /)no
PNA yes / l"
ZI
❑ PTS
❑ N/A
Street Address/ State Road/ Lot #(s) }
Subdivision
City ZIP
Phone # (t'-' ) River Basin
Adj. Wtr. Body „1 (nat /manunkn)
.j
Closest Maj. Wtr. Body
C
OMNE' � :mCmm�mc_:::__:M-W_:_�I
-
■■■■■d�■■�n�.■■■■■■■■►�►�t�i■�IIi���I/
R1li[Gie�Sf
ll■���■■
■■■■■■■■■■■■r�■■■:S■■�■■�
■�■■■O■■■:ti
:i::
d::::::::::::::
:�:■■:■:S:��■iuii�
■
■
�
EN
■■■■■SEEN■M■ESE
IN
■■
■E■EEMEEME■■■EEMI
wS®■ESS�iOS■E■■S■SOMEN
■■■■■■■M■■
■M■Ml�■■■i
®■E■�
�!/I■90�!!!IS■■■
■■
NONE
M■■■■
i■.
■
■
■7r//■MESS
ME
:■E
E■
/.■■■■■■�
■E
■■MI
ME
■Mid■S■■■
■■
■■■E
■
■�
■■■
■■MOEM■■■■■■■■®■
IN
�FARMI■■■■M
�M■
O
0
OEM
0
NNE
ME
OO■MOO■:EN
IN: ■■■ ■■■■O�■■
M.SEES
SEED■::5�:
�OO■
50 NIMOS u■■ ■■
■■■■■■■■■■■■■
:1
NEE
�a :E:■■:::::::
■■■ ■■■■■■■■■EB■■■■■M■
IN
IN
■■M■■f■M■IlYdli■■ ®■M SEES■ ■
■■■■
■■■■■nS■■■■O
■■■■■■�■■
■M■■SEE
rr!■■■E■
SEE :�1�■■!t/■■:S■S■::■■S.
SEES SEES■ ■O ■
■:Ma■� ■
■SEEME
■.l[U1■■ u!■M■��lSM
�■■M■ml■■M■■■Eifl■■■■
■u■■■S■■►�'i=:::i:i:E::::■i::i:��
�=M■■■■
SEES■■■
SEEN■■■ ■■■■■■O■■■�■■�
:■■
■■■■■■.....::::M■::::::::::H■:.::■:
......■■...
wpt ;
A -.-
Please read compliance statement on back of
Check #
Permit Officer's Prin[ d lame / {
Signature
/ii/`� %i .
Issuing Date Expiration Date

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request: & / .3 / / 9
Property Owner Name: W A L• i f 2 r 1/0 A 2 ,N
Address of Property:
Telephone Number: %/ % S,12 3 9 tl `j 2
Type of Work: (Ffi eI Ada nro I.(t , G d- `I
m'79vr_
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 byDCM.
Signature:
RECEIVED
(lj�JUN 03 2019
ai I o
DCM-MHD CITY
NC-
�-�

ADJACEN7_RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L%J A1,7Cg F (7Ea) W NRw 's
(Name of Property Owner)
property located at 1/7 SAt.N rNogss PorNT- �R
(Address, Lot, Block, Road, etc.)
on 30JAE Soow]> in .vmt. jpea r N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatioci.
1 have no objection to this proposal.
lhave_objections to.this.pr_oposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below or attach a site drawing)
1?FP,4i(z i7 o c14
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.)
CAJ 1 do wish to waive the 15' setback requirement.
! do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner
Signature
Print or Type Name
_t LXFA iE W AR,tr
Mailing Address
117 Shcry JR02& Pa rr DFt
citylstatemp
Al eW Po AZ— N C 286770
Telephone Num er
Date
f-�- ---- ---
sL.n�4-4-e- -� - Nome I1
Print or Type Name
1114y Si ore s Toi n4 b r
M tang Address
�?Qori 14 C --;?g5w
citylstatelzi
To-9�1—1719
Date
(Revised 8/182012)

I,
U
6i 16
N
O
Q
U
L
0
0
F
W
LO
W
L
w
F
Fn
cv
q
WW
v
F
AU"El
q x
x
A
E �
nv
a
�
a'a
oCi
a&
N
b�
7
ti
Ex
a
ffi�
�a
�d
�s
v&
ob
�m
cg
5$
8�
�U
�8
8UR
F
Ag
E�
S
a �m.
o g�ffi
z u m
5ffi;y�y;((
Leib
pU�
DNm
h � � u
N 0 L
°' 3
r N LO
LO
a a
}}+
M W W N O GL N N h.m i
°o Q a a �s�
o''a
oF p E
W "�i ro rb {y •^�i V1 r^i ro ' m E
`o 'o
� U
�_ \ N NFU
O O L
a rn OD S $ M w
co
AFi W V o0 O � mb O\y' O E[..�� ��11 M 00 N LO O O O \ LL
M Lo 0,LO co
a y E
+� 3 W e7 tsi m
a s F r a x o Ohm
a d Q 3 a oa x ro ro r~ . E a