General Permits (1777)

Applicant Name
Address
City
Project Locatjon
Z"7!t 1
Type ,and Dine
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT f
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.
Phone Number
(County, State Road, Water Body,
lions of Project /e-o >!
State,,/ Zip
iW
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH U V .+`. y .C�/�'" (SCALE: )
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
s a subsequent determination that a permit was required for the
evelopment.
The 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.
Applicant's signature Y
CAMA Official's signature l/
issuing sate
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

•
•
.. •. a* � � .. ... .. 1. T R a �•' ...
/I 4
%�. 7�`.rs--""'-..`.,'..;.. n 1�..�'u^1^^'l ✓`.._Jti--'".�_n !l %-S!'�`c. �, h i'�f.... ...7\ /h,.. /'�--�'.-..r_.l .-�. Jti /�._��. � /'�.._%''-,. it lY_ T'1 1�. J

4 93
IA �nee
7q.
rq Bo
i n 5 -/0 / c, s
f- 6-a3--����
0 snob y S;

'
GENERAL PERMIT APPLICATION INFORMATION
�
d
n ,
APPLICANT'S NAME:
''' + 4 bC-
1 n 4)
(Fir
t) o (Middle)
rn
(L t)
)&ING ADDRESS:
D Lc ..'
`. t.
(PERMANENT)
t
STATE ' ��
ZIP
TELEPHONE:
WORK ( )
HOME (9L�-) J a)
2—
CONTRACTOR'S NAME:
TELEPHONE NUMBER
PROJECT LOCATION:
N.C. Hwy. #
SR # Road/Street Name
% n S p
,, 11
Waterway Name W h} e Oak kiy e r County CCU 1
Town
Subdivision ( -r- Tr
PROJECT ACTIVITIES:
PIER: Total dimensions of pier from MHW to platform
(Length) (Width)
'T' or 'L'-head platform
(Length) (Width) (Number of Mooring Piles)
Water depth at end of pier,
IF HOUSE/BOAT LIFT: Length
Number of Piles
BULKHEAD: # 1
#2
Total length
Average distance waterward MHW
Maximum distance waterward MHW
Total length
Average distance waterward MHW
Maximum distance waterward MHW
RIPRAP: Total length
EXCAVATION: [MAINTENANCE 'ONLY']
Number of Mooring piles
Width
Water Depth
Base width from MHW
Length Width 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 Backhoe Hydraulic
OTHER STRUCTURES:

Hi�4,��y 5� fo �?r�r� IYla�svi'I�-e,�u'Yn
Laos , sR 11a9, �a +a- w�5f •
f o LJ r lid
8in5ton It'd SR la�,�4, �.�-�.� r qD°
w�+d,r�' pa-+h -�o �re�en
h t� � ?
•
5�