General Permits (4906)

�0CERThFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT / a
as authorized by the State of North Carolina, �fsw.
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 r tom' " ; Phone Number i 9
Address
City State zip S l �•
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.
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examinatior+of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: )
_ •� ���,- yam- --- � `�..__—___-. _
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.
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 Al
CAMA Official's signatures
7.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

APPLICANT',4; NJUME:
M&--JNG ADDRESS:
(PERMANENT)
GENERAL PERMIT APPLICATION INFORMATION
J
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(First) (Middle) (Last)
STATE /ILA, ZIP
ZEIJ:PHONE .. WORK (91 _ LF1
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y HOME ( 9 Icl) �.�� - � �• ' 2
CONTRACTOR'S NA?4E:
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TELEPHONE NUMBER
PROJECT' LOCATION:
N.C. Hwy. 11
SR 11
Road/Street Name
' -
Waterway Name
`Town
H County
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L
Subdivision C 07YT0� �rlY
PROJECT ACTIVITIES:
PIER: ._ Total ^dimensions of pier from MHW to
platform
(Length) (Width)
ti
1-V or 'L'-head platform
(Length) (Width) (Number of Mooring Piles)
Water'depth'at end of pier.
F T HOUSE/BOuiT LIFT:
Number of Mooring piles
Length Width
Number of Piles Water Depth
BUL�AD _ 111 Total length 7 - /a �.C) / U - 1 .? %rO / - /0 3
Average distance waterward MHW
.; Maximum distance waterward MHW
#2 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
Dr.gline Backhoe Hydraulic

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ADJACENT RIPARIAN PROPERTY OWNER STAMEMT
hereby certify that I own property adjacent to
(J h %t 6✓-� Is property located at
(Name of. Prope/r-t Owner)
} (Lot, Block, Road, etc.)
K 1%4J A L {� �m -c a , N.C.
on /��v_F r � �Fi N in Oil. "T
(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.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
.(To be filled in by individual proposing development)
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fur
AJ FC) f &'-- ,'01 (ia,
Sign a ure
T)7 a > 6'
Print or Type Name
SW nzy f2l
Telephone Number

FOLEY& LOLEY
MARINE CONTRACTORS, INC.
P.O. Box 3482
New Bern, North Carolina 28564-3482
tww
y� P 11
-� 13 NOV ti
FOLEY & FOLEY MARINE CONTRACTORS, INC.
P.O. BOX 3482
NEW BERN, NC 28564
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
you �°l7gy?o� 's property located at
(Name of Property owner)
(Lot, Block, Road, etc.)
on lV us R , �s� � , in OI%:y141 401, ea J. 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)
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Print or Type Name
Telephone Number
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