General Permits (4951)

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CERTIFICATION OF EXEMPTION
5
FROM REQUIRING PERMIT
! / QU G A CAMA
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 .02aa.,
Applicant Name t.' v •f' ,Y SVAJ Phone Number
Address
City State Vr, Zip
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 forgo days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH I ' (SCALE: . . - ) I
✓�� rf �.' ,.. Y1 � �
)):E i1, <-tu'L
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.
I jI
Applicant's signature f �'
CAMA Official's✓ signature
S
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

08/08/2006 11:27 12526355242 MEDFORD MARINE CONT PAGE 01
MEDFORD MARINE
CONTRACTORS , LLC
410 C14LJRCH RD.
NEW BERN, N.C. 28560
252-6354242 OFFICE
252-229-1+915 MOBILE
252-635-5248 FAX
Sond ta,
From:
tendon: f .. T
pate:
phone Number:lp 5- -
Fax Number: S, 7- O
lntal pages, including cover: --4

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ADJACENT ILL PAFJX PROPERTY OWNER grAMrLN7
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r hereby aatfY that r own property m ��S . �l �,�/�3_ %,,,,
(Nam of Propr: Owner)
p vMty Towed at 7e,61
(Lot► Mockd, ate.)
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(W y) (Tavu andlnr County)
Ar bas deabed td me, aS town below, die dot he is proposing at dasa loon,
sad, r haw 00 akeCdow b his PMPCUL F tntdwMnd tha a pie~Imoo,uag
p�7 ings't�xtiitllbai se tssust be = hwk a minimum dfs=cz of fitlau f= (15,) fmm my i-=
of 17' 46= tt+acxn aaiesa moved by me.
I d n no wish to wai•.-e the stt#mk Mgwrt3ment
I to wish to wwvc ttu setback tequirrm=t
DFSCRaMON AND/OR DP--k*r G OF PROPOSED DEVELOP,M,T;
(TO be jfzw in by irrZdrF&Mj vMparuj devsbpeatejW
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Print of TAM Nana ---�
Teiepile Number
60 39Vd 1N00 3NIdVW GdO303W ZVZSSEKSZT LZ:TT 900Z/80/80

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a.at, Biacj , EZan C-
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and. I haw zw ob w=ms m bu pra;cmi I =dmvmd dw a pia-lmaanng
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of r4mrM area mama waiv d by me_
I An„ftelj wish m Waive Me Z♦etttiack r quiresse tt.
!/r I dp rriah so waive dw nda Wk Nqu immC+t
DESC3,.Mlori A.WD/OR MAMMA OF PROMS= DEyIELOP-SM T.
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Pftt oc Type Naas
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Tefephone Numbs
V0 39dd 1NOO 3NIdVW GcIOJG3W ZVZ55EKSZi LZ:ii 9007,/80/80