General Permits (4908)

CERC IFICATION OF EXEMPTION
-fir• _
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,S 0-do-,
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 1_Gc"[A_Y _ ? r!" . { u� Phone Number b j 7
Address
City �. , State Zip 4' ;
Project Location (County, State Road, Water Body, etc.)�2ea,.
Type and Dimensions of Project Gf�y�./ ' If'y
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.
SKETCH
j
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.
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.
(SCALE:
Applicant'sr7ignature J" n
CAMA Official's signature i
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

CENERAL PERMIT APPLICATION INFORMATION
to P.?'..ICANT' S NAME: A U
(First
M.-- ING ADDRESS:
(PERHAKENT)
S
Middle
Last
/%&6
/ylc.4�
STATE IVC-0, ZIP
TELEPHONE:
WORK (9/ 7
HOME ( `lam)
CON 'TRACTOR'S NAME:
hdh rE y
d Fa 4 E • e
TELEPHONE NUMBER
PROJECT LOCATION:
N.C. Hwy. #
SR #
Road/Street Name
� Waterway Name - of �i ) Ft 14
County TA yq , k C d
)V�
Town
L
Subdivision 129 yTo,�> 9►9y
_C
NJ
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 HOUSEAQO T LIFT: Length Width
Number of Piles Water Depth
1a7,
BULgHF.AD: �/1 Total length A6 I -Z ' 3
Average distance waterward MHW
Maximum distance waterward MHW
it/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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Ito 194-
SO
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IpcWtqd at
owngrj
etc Lot,, BUZZ
on--
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p0a)
dGs=ibA-d to me, as Sbam bawt the developzent a is
proposing at that'location, and; I have to allbjectionS his
PZS(LRIP=0M AbM/0P.'R?jLW.TNG OF DROPMM
-lapa in by idlial zim< elevabjpent)
(To.. to propQ j
?L
County of 16012A��
State of 2�
My Commission Expires June 13,1993
0
S

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
4-� 0�J 's property located at
(Name of Property Owner)
(Lot, Bl6ck, Road, etc.)
on �i/Fufh` JE" , in 02:izv1�� IV,+1� co , N.C.
..(Waterbody) (Town and/or County)
H.e.h_as 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)
S E E A7 T2 0 1
k
`Signature
Print or Type Name
Telephone Number
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JPERTY OWNER STATEME2IT
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h property adjacent to
's property.located.a
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in 6R;AQ)401 l�w,:l�a , N.0
(Town and/or -County) .
wn below, the development he.is
d, I have no objections to his
-------------------------------------
7ING OF PROPOSED DEVELOPMENT:
Lvidual proposing development)
Wont ,Y JUaT
LQr�v
co
,Signature
Print or Type Name
;^ Telephone Number

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