General Permits (982)

` OERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,"
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
s _
Applicant Name ' ' fi' Phone Nu U _j
Address _'
City f_
Project Location (County, State Road, Water Body, etc.)
State
Zip
Type and Dimensions of Project - 'f
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
We applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
Applicant's signature 77 7-
CAMA Official's signature
5
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

T GENERAL PERMIT APPLICATION INFORMATION
APPLICANT'S NAME:
(First) (Middle) (Last)
LING ADDRESS: �/ g � � i Sd` .'LNi12Gt�- GL�' �.c� r
(PERMANENT)
STATE f ' ZIP
TELEPHONE: WORK ( �) d '-3 .a, �J/j HOME ( )
CONTRACTOR'S NAME: TELEPHONE NUMBER
PROJECT LOCATION: N.C. Hwy. I j �'' SR # Road/Street Name ,5ru.,,r1i
Waterway Name County
Town Subdivision
I 4L, -
PROJECT ACTIVITIES:
PIER: Total dimensions of pier from MHW to platform
(Length) (Width)
'T' or 'L'-head platform
Length
Water depth at end of pier
�NT HOUSE/BOAT LIFT: Length
Number of Piles
BULKHEAD: VI Total length /
112
(Width) (Number of Mooring Piles)
Number of Mooring piles
Average distance waterward MHW
Maximum distance waterward MEW jwl
Total length
Average distance waterward MEW
Maximum distance waterward MHW
RIPRAP: Total length
EXCAVATION: [MAINTENANCE 'ONLY']
A
Length Width
Width
Water Depth
Base width from MHW
Depth of Cut
Adjusted water depth on MLW Existing water depth(s)
Estimated Cubic Yards (length x width x depth/27)
Type of spoil: Sand Mud
Dragline
OTHER STRUCTURES:
4; d
Backhoe
Hydraulic

G
IL71 t77�'

ADJACLNT RIPARIAN PROPERTY OWNER STATEK:NT
I hereby certify that I own property adjacent to
s property located at
Name
Property Owner
M
(Lot, Block, Road, etc.)
on /-A s4_ N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
ii
n
Signature t'
Print or Type Name
39- o
Telephone Number
� 1 �J

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
(Name of Proper y Owner)
(Lot, Block, Road, etc.)
on `C , in C a , N.C.
(Wate body) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
I
i-Z
I �Vature
l int or Type Name
lc" -,Id
i vTe' ephone Number