Taylor, Nelson IV

GCAMA / ❑ DREDGE & FILE i, l ' `NO; 74909
A B C D
GENERAL PERMIT Previous permit#
6A New,, ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued
As aut ®rued by the State of North Carolina, Department of Environmental Quality
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and the Coastal Resources 9ommission in an area of environmental concern pursuant to 15A NCAC ;
Rules attached. i
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Permit Officer's PrinteNa
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Issuing Date Expiration Date
I Gl(.'

Hurricane Florence and TS Michael
Replacement/Repair Request Form
Date of Request: -0/Y �o / c
Property Owner Name: N2 t ion �aI6o, LIB
Address of Property: 1604
Telephone Number: �Ts i lzc),2 02 )(o
Type of Work: %� %inr 5ti it �oT 2;(5�„r y1 r� �^arA ti/i udr.Q
ri'r-y Cvno" G94?<-YAr Srna(4 gpmWel'
NOTE: 41 54/Zp_ -p C,1'-eyrod"b'q caG qee ,by /r, �loi2HG�
• 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 ma3ce excavation or dredging requires signatures of the adjacent riparian
prop ert o e (sy= the notification forms provided by DCM.
Signature:
RECE.NED
MAY 14 201
DCM-MHD CITY

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