Whaley, Bobby

❑ CAMA / ❑ DREDGE & FILL �78904 • /89A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resourc s Commission in an area of a vironmental concern pursuant to 15A NCAC
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Applicant Name i.��_ 1: �. tT �K (-�, Oq Project Location: County_
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Phone # (—•-)� E-Mail
Authorized Agent
Affected 71 CW ❑ EW ❑ PTA ❑ E( ❑ FTS
AEC(s): OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
1-1 PWS:
ORW: yes / no PNA yes / no
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Agent
^orr Applicant Printed Na'm,e,
Signature- * I_eaS read compliance statemento backofpermie**
Appliwtiofi �ee(s) Che k#
Permit0(ficer's Prin edifJ)e - �—
Sign
Issuin Date ' Exq' ation Date

NC Division of Coastal Management
Hurricane Replacement/Repair Request Form
Date of Request: 2 Z U 2 U
Property Owner Name:
Address of Property:
Telephone Number:
Type of Work:
/7 2 pn U(,voaP Z AAIc
72 6-1975
I�,p4p� [?ULJ�NEAD
NOTE:
• The Emergency CAMA General Permit 2500 is for repairs and replacement of water -
dependent structures damaged because of a Hurricane. 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: wd�