Gilbert, Gerald

CAMA / 1:1 DREDGE & FILL
NI? 78950 A B CD
.1OBNERAL PERMIT Previous permit #
7"New ElModification 171 Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ... ... 7
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC J
DRples attached.
Applicant Name J,' Project Location: County I I I
Address
city State ",A ZIP J
Phone 'E-Mail
Authorized Agent
Affected I Efcw El " EW 0 PTA El ES El PTS
AEC(s): 71 OEA E1HHF EIIH OUBA EIN/A
.,--Ll 4WS:-
CRW: ayes i ho rMM yes// no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) I
Groin length
number
Bulkhead/ Riprap length
,avg distance offshore
max distance offshore i
Basin, channel
Boat
Boad
Bearl
Other
Shoreline Length i
SAV: not sure yes no.
Moratorium: n/a yes
Photos: ps ., (no
Waiver Attached: no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Street Address/ State Road/ Lot #(s)
Subdivision
r'7
City ZfP
Phone # River Basin,
Adj. Wtr. Body-- 46at /man /unkn
Closest Mal. Wtr. Body
(Scale:
"I I #
El See note on back regarding River Basin rules.
Agent or Applicant Printed Name PermitOfficeirs Nhted,'Name . . ...... ......
Signature *t Please read compliance statement on back of permit Signature,-,
Application Issuing' DI'te"
pilcationFee(s) Check#

NC Division of Coastal Management
Hurricane Replacement/Repair Request Form
Date of Request: _,112�2QZK')
Property Owner Name: i be r k rC I (`z�rai Alba. HE
Telephone Number: Z=�2 L15(1•Lnl(Q(n
Type of Work: y to y\,
t-0.wreree+Son Arco) covti, leie, wcjr•K per,di `q Pe��:�
NOTE: J o �PrpU0.l
• 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:
Aec io,.l view of` dar na�ed doel( o,.Ho_cked .
rlen.�1 ip be, reFcxlced ®UC.(- scuv.e, �pp'4 Pc1+nF ,
FEB 1 2 2020
DCM-MHD CITY

ADJACENT MRARIANPROPtRITUVY{VLK.IINOLf�1V°�
I hereby crtify that I ou,n property adjacent to
(Name of prop" :Ow
properly kxsted at `��i� z i3C Cl
r (Address, Ljo� Block, Road, etc,)
00 � tit `�C�..I E^�M , In �L�.{l t' NoS S E 2=}1C.i. �i-� N G.
tVvaterbocty} jr_dyffown andfor ",puntyJ
The appli4,gr)t has deschbed to me, as Shown below, the ds)rel4lprnent propoked zit �Hie above
location. /
i I have no Olp o'tiori t4� this proPOsai.
-
pESQRtPTIQN q D;GR DRAWIN+a OF PROPOSER DEVELOPMETJT
(7rr&vidua1 proposing development must fill in description.beiow orauaGk a site &vwiaw
c'xsc.y'�
7O1 '�Iiec'
C-eIr"ot"Ev_
WAJVFR SECTION
._ ` under!ari ..(i th8t a pior, dac ,, mooring pilings, t>reakwater.. br.,athoia.,c, Ilft, -jr (Oin rivet be set
back a mini Um di$tWCO OF 1.' tTOm my area of riparian acj)E.,,6 tl nlBss w2M--'6 by lrt}- fit'.` you
'wish m waive the =eth3cF:, you mustinitial t�)e app mprialc bunk below `,•
lS V S dowish to waive the 1 8C'aack requin me-M..
` I do not wish to omive the 5.S aptback requ<rempd.,
(Pmpert'y OwTvr tnfOrmaation;t
f A- >T--
Si�rt.r�,rc
Pwa gar Typ-, Naaoe
,An Ililztli1 E
dda;fir�r �.dc'ress
CiTyr3Mte .0
Tak�.p7hwr o wrnm «r
Date
(Adjacent PT"etty Owner lnforinaYien)
,[ RECEIVED
(R7vtgcQ 611P'Pr; f 2)
FEB 2 9 2020

JWJAGENT RtlswktA&pigtstrt?arrt' W R 3 A7�iMEerC
I harebg certify that I own ProperCy adJaceat to j s
{Naema of Prop" Owner)
txoperty located at
(Add"Sa, Lot Black, Road, etc.) N C.
00 - S"' -- in jC awnandforOouftvJ7
(Watetbodyl
Ttte applita+t has described to me, as shown below, the dowloproertt Proposed at L'te ab"
locaiig>
t� i have no o4ieCtaon t0 this proposal.
Lttaut�QgiectiQr�&fa.'.Lds•t�aposftl......._._ .. ...___.._ .. —... -- - � -
DMCjjpTl()N ANI)toR QRAVANG OF PROPOSED DEVELIDFOW
(frttdi+tidtta! p%posing development m;,W fill in des4000n below Oratsat h a site drawtrrO
TO' P4e.0
t-erots�."ak! 4xaCo�eKci�"-
WAIVER SEGuloN
S under-ia.ard that a poor, dock, mooring pilings, tgl3akwaler, baatt• vqe, CRt, ar groin muet be sect
back a ntin�mum aista. i e of IV from my area of npadan aeeass ur4e5.cs watwd by IM jlt you
wist, tc wniye the setbacK yov. must inttial are appmpraft blank below:
CLl do wish to waive the 16 satback requirement.
I do not wish to wove the 16 sstb2ak requ.rarrrenL
(Property Owner tfitOmwtionj (Adjacent Pv"arty Ckwer leformaticn)
rn
Gars
7,1d f
fP&vmad OWPO 12)
FEB2 ® ZOZU
DCM-M ` D CITY