General Permits (6053)

.Y EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Deparimentof Environment, Health, and Natural Resources and the Coastal Resources Cornm ssion
in an area of environmental concer 3.
Applicant Name 6.lei /� , �j' Phone Number 9
Address
City State — Zip
Project Loc tion (Countyy„$tete Fla , Wet Body, etc,) A40
Type and-Dirneingions of Pr ct
The propo sad project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit ra-
quir®meet This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Locat authorization.
Tb Is tl frorn requiring a CAMA perm t Is
valid 16004WIs from the date of Issuance. Following expiratlon,
a re-examination of the project aid Project site may be neesssary
to continue this certification.
'SKETCH (SCALE: )
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Any person who proceeds with a development without the oon-
sent of a CAMA official underthe mistaken assumption that the
davalcpmeni is exempted, will be in violation of the CAMA tf them
is a subsequent determinaZn that a permit was required for the
development.
. he applicant Certifies by aQnlnQ this etixemption tnat ,1) the ap-
p leant has read and aw1b abids by the condli ons of this exemp-
tion, and (2
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PW�
Appli n 'e signature
� 7c .j /0
CAMA tic a s s•g ure
21 lssu ng date
-7, ..?/-
Expiration date
A,ttachmont: 16 North Carolina Admrinietrat'va Code 7K .0203

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MEDFOR D WR I N E CONST.
P. 0. Box 3556
NEW BERN, NC 28564-3556
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IIMsxaw or
Name Of Zad ividua.l Applying For Parsib, _M q I cs,n C 4
hddross Of Prcperty : !_ 3_ J X kee S'PrJ'41
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{ Las t e� or , C t oumiy )
I hereby certify► • that I owrr proyetty, adjacent t0 • tAs above -
referenced prop4rty, The isdiv d�ul appiyirq for this ;trait has
deseribad to as as ahowri on the attached drawing this devolopAent
they art propecihq. A daserlption or drawing, vtth dimensions,
should be provided with this letter.
X I have "o ob jeetiom to this proposal.
S
I Unde:stard that a pier, dock, scoring pilings, breakwater, beat
house, lift cr s"bags east be set back a Minimum distance of 15,
from my Ara's of riparian &cc&" unless Waived by stir. (If you wish
tc vkiva the setback, yen M= initial the appropriate blank
belew_j
GI I de wish to vaiva the 1 5'setback regairemerit.
r Z 4A-Imt wish to vulva the 1!'aetbcck requixe~%,
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MEDFORD MriRIHE CDNSL
P. o. Ilex 3556
NEW BERN, NC 28564.M%
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Nana of individual Applyinq Tor Permit'. 1 Ce•n CA
Address Cf FropertY: 13 6-r,ee S s R d
806V 8 efn N.r , a
(Lot-Orratrett ri Street or Road,aun Y )
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I hereby cartify +that I own property adjacent to.the above -
referenced property. The individual applying for this permit has
described to ve as shown on the attached drawing the development
they are propoz inq . A d'eacription or drawing, with dieensions ,
should be provided with this letter.
x I have no objections to this proposal.
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift cr sandbags must be sat back a minimum diatanca of 158
from my area of riparian, access unless waived by me. (If you wish
to waive the setback, you XYtt initial the appropriate blank
T do with to waive the 151setback requirement.
_) I dpgt wish to waive the isisetback requtirenant.
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P. O. sox 3556
NEW BERN, NC 28%4-M
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Name Of
Individual Applying
For
Permit:
Chi f �>
Address
of Property:
(Lo or reQ res or Road, City & County)
I hereby certify -that I own property adjacent to.the above -
referenced property. The individual applying for this permit has
described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
shouta �k7ided with this letter.
ave no objections to this proposal.
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbags rust be set back a minimum distance of 15,
from my ere, of riparian access unless waived by me. (If you wish
to waive the satback, you rust initial the appropriate blank
below.)
I do with to waive the 15'setback reouirement.
I do not wish to waive the 15'setback requirement.
�eleuficne Number With Area Code

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