General Permits (4907)

Y
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, f
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.
l
Applicant Name % Phone Number
Address
CityAr
' - State Zip
Project Location (County, State Road, Water Body, etc.), '
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.
.st y /'; 41,
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examinatioh of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: ) I
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.
11
App1)6'ant's,61 nature
CAMA Official's signature`
I /- d
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

Opp"
APPLICANT'S NINE:
Ht-TNG ADDRESS:
( PERMANENT)
CENERAL PERMIT APPLICATION INFORMATION
r4L)L
(First
I
iddle
Last
/V&6 d4e/J STATE IILC-0, ZIP ?tea
TELEPHONE WORK (9 / 7 627 - L/ I / V HOME (9�2
COFACTOR' S NAME Qh y d f o 4 E�e _ TELEPHONE NUMBER
PROJECT+ LOCATION: N.C. Hwy. # SR # Road/Street Name
Waterway Name �/ r ;06 K County
Town dui i, /j L Subdivision Q 1Z9YT0j_> Fr9Y
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 Number of Mooring piles
F T•HOUSE/BQuT LIFT: Length
Number of Piles
i
Binan^ /il - Total le
Average anc
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']
Width
Water Depth
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

,."14ft,,
'Ook
N
)VLVU5

4
ADJACENT RIPARIAN PROPERTY CUNER STATEMENT
I hereby.certify that I own
property adjacent to
<ti
Is property located at
(Xame of. Property Owner)
" (Lot, Block,
Road, etc.)
_ on cvn„ , in is: IMI)CO, 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)
IVFL)Jrt
7T
its
si nature
print or Type Name
County of
State of
Notary Pu is
'elephone Number
r
My Commission Expires: !!yCamrnissimr-Exp+resJ&n 31- 1992

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
certify that I own property adjacent to
Print or Type Name
`Telephone Number

-i
FOLEY &FOLEY P o A
MARINE CONTRACTORS, INC.
P.O. Box 3482
�._—......�—. r
New Bern, North Carolina 28564-3482
FOLEY & FOLEY MARINE CONTRACTORS, INC.
POST OFFICE BOX 3482
NEW BERN, NC 28564-3482

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