General Permits (5751)

C.ERTIFICA-TION.-OAF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, 11
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission ✓
in an area of environmental concern pursuant. .ta.,..5.NQACZubchsapter_-7K .0243..
Applicant Name �,rc�,rrY s; ,w', Phone Number
Address —P a,r ?.j7
City 6&,,A '✓;/le- State yA Zip 'o/did
Project Locationi0ounty, State Road, Water Body, etc.) , SAS' �y,f
Type and Dimensions of Project 4-0a W 2,A W_
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement-pursuant-te--1-5--NGAC--74<,,Q--Q. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
rAJ i>>.a
This if cation of exemption from requiring a CAMA permit is
valid days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
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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.
r
Rppi+cani s su n�ure
*) /6 �G!f
CAMA Official's 0griature
f - 96
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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179

op PAPPOO CrBpTy RAW?
NC 28�15
[phone]
r ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPN�� ��^ �J
1 hereby Certify that I own property adjacent to RICHARD SMITH
on GALES CREEK & BAY RIVER MISIC
(bed of in/near
fat o� Y water) .(Community)
M05-5 (Subdivision if applicable)
Tax Parcel # off SR ,[„2� , Complet deaoription
of. how t0 locate th18 property: 304 to Mgsic East on 1224 lAt on
Gales Creek Rd. continue to end of road.�'•
The proposed project a
- and the location has
boon described to me ae shown in the drawing below and I :have n0 objeetl,o4s-, '',; -
ts tha propoeal.
f; ..
Wish to waive ' . `.' . • .. ';� ,.^,,;;;,.. ;,,
�- ve the 15' minimum set back from m
•�� Y riparia�a �oae.ee,��, �r;.e•-,. ,<.
._. I DO NOT wirsh to waive the 15' minimum act back rsQuiremeAt.'`•
Draw the proposed structure in the space provided below. List the size of
the structure and measured distances from the adjacent property lines,Other'';`r�°
atruct4res.on the property, and the road, water, eta.
REPLACE 786' +/- of bulkhead with anew bulkhead or stone revetment. ;...�.•�+;
r 3 JA
U6.0 5 1
SIGNATURE s
C�2aE.5 �. 6V ea.r-o 11 r ;
NAME, PLEASE PRINT '
r

[AMICBO�OM, RAW? NCS28 TP" ,
0 [phone]
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPN�t '1':'I
I hereby certifythat I own RICEIARD MITE!!
property adjacent to r
t[�ns{.od Qn GALES CREEK & BAY RIVER
in/near MESIC
4ot IFN/A ( body of water) N/A ( community)
of
M05-5 (Subdivision if �>�g�licable) T" Parcel >s off SR
Complet dencriptton
of how to locate this property: 304 to Mr'sic East oft 1224 left on
Gales Creek Rd. continue to end of road. Al
The proposed project, aand has
been described to me as shown in the drawing bed,ou andtIe;iav®ano �ohject�.or
. t4 U&e3 proposal .
;.,..... I wish to Waive the 15'
minimum set beak from my riparian ipge46
.�._ I DO .NOT wish to waive the 15' minimum not back reQuiremept ' wi
Draw the proposed structure in the space provided below. List the size of
the structure and measured distances from the adjacent property linen, Other�;:+
etruct4res on the property, and the road, Water, etc.
REPLACE 786' +/- of bulkhead with a new bulkhead ov stone revetment.
Y 1. •.
1
AUG 0.
DATE lb - M2
NAME, FL
PHINT