General Permits (2193)

-� CERTIFICATION 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.
Applicant Name �,i , ,� mil/,� r�'S Phone Number
Address `K
Citv
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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
Ovelopment.
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.
State
Zip
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
CAMA Official's signature
Issuing date `
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

P' GENERAL PERMIT APPLICATION INFORMATION
APPLICANT'S NAME:}N ��15
(First) (Middle) (Last)
AING ADDRESS: Z L a, W ! wghEop
(PERMANENT)
STATE
TELEPHONE: WORK ( ) HOME
CONTRACTOR' S NAME: S : E • Tu(n TELEPHONE NUMBER
PROJECT LOCATION: N.C. Hwy. 5SR Road/Street Name
Waterway Namer�(aE C.Y�5/L—,4 . Countyj
Town C— Subdivision
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
.W HOUSE/BOAT LIFT:
Length
Number of Piles
Number of Mooring piles
Width
Water Depth
BUL.�AD: #1 Total length
Average distance waterward MHW
112
Maximum distance waterward MHW
Total length
Average distance waterward MHW
Maximum distance waterward MHW
RIPRAP: Total length Base width from MHW
EXCAVATION: [MAINTENANCE 'ONLY']
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:

. I —
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L.
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A441fflOt2EP19 �lZ
5filt-
I hereby certify that I own property adjacent to 7U*4 _ UIL-LI S is
property located at 6mt�?-ic�C1L 1:kZ
(lot, block, road, etc.)
on �� C�C1l� 5c�c�1�1, in Ef'Yi-� L_ , N.C.
(water 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. I understand that a pier must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I do / do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
4
K
A7
Signature
acV (n
Name
n -
Ph eno Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A-P+PrR+
S61gG I-C. 1EE:'P1}itZ
I hereby certify that I own property adjacent to-7;b4-?4 IL-fS is
property located at tLo & 6"V9LLD '�2
(lot, block, road, etc.)
on�� 5���'!y in�-� S C� , N.C.
(water 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. I understand that a pier must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I do / do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
Signature
Name
Phone Number