General Permits (7203)

CERTIFICATION OF EXEMPTION 0
FROM REQUIRING A CAMA PERMIT
• as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
Address 2
City `* State Z Zip,
Project Location (County, State Road, Water Body, etc.) ' lr/2 52- cr
Type,and Dimensions of Projec -4F'/
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.
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
0velopment.
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 60 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
Applicant's signature
CAMA Official's signature U
Issuing date
1
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

GENERAL PERM APPLICATION INFORMATION
APPLICANT'S NAME:
Pai E
C7 1 LL 1 D -S
MAILING ADDRESS:
(First)
V7—( 5
(Middle)
(Last)
(PERMANENT)
�
t4.c ����-�
STATE
ZIP S 76
TELEPHONE:
WORK ( 1 i 0)
HOME
3-)
CONTRACTOR'S NAME:
m
i9-(L% NE CU�(S7'TELEPHONE NUMBER / -?- 3
PROJECT LOCATION:
N.C. Hwy. # SR
# Road/Street Name
Waterway Name "'BOc:>CA.C— SpUjJy County
p
Town
Subdivision
PROJECT ACTIVITIES:
PIER: Total dimensions
of pier from MHW
i
to platform /�7 c-�
0
(Length)
(Width)
'T' or 'L'-head platform R C l"
(Length) (Width)
I
Water depth at end of pier � -to 7 (
BOAT HOUSE/BOAT LIFT: q0eng A
Number o Piles
BULIMAD: #1 Total length
#2
Average distance waterward MHW
Maximum distance waterward MHW
(Number of Mooring Piles)
Number of Mooring piles
Width `
Water Depth ! - S rT
Total length 1111
Average distance waterward MHW ��
Maximum distance waterward MHW
RIPRAP: Total length
EXCAVATION: [MAINTENANCE 'ONLY']
Length
Width
Base width from MHW
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
Dragline Backhoe
OVER STRUCTURES:
Hydraulic

L��
t/�Y � y �,� �7-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
I hereby certify that I own property adjacent to Pp� —IF —Po �� IS s
property located at Foj ��3 �JeWe4Y-r t� C
(lot, block, road, etc.)
on pC,(xt S�'aMb in H IX (E�� N.C.
(water body) (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. I understand that a pier must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I do d�not ish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
g4 CyUC-
Q 1S`1"
nm�
AUG 1 7 1994 j
�Z' 1ti
Do�K N
f.l GI -I �� _ , 4
4
4-,tdt
0
Signature
v ULIALTO( .5h?l5-rQ
Name
,Rtq) 3q3 - Z4-00
Phone Number

c � ep p
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER)
I hereby certify that I own property adjacent to:2 P�JE ? f 1 I L"L-/ PS Is
property located at �Y• s F�'a K % S 3 Pe\'LJ
(lot, block, road, etc.)
on (B©GUlC S©flyl� in CRN.C.
(water body) (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. I understand that a pier must be set back a
minimum distance of 15 feet from my area of riparian access unless waived by me.
I do do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by individual
proposing development)
_f5`4 L
igna re
Name
(qiq) Z2�- CD�SI
Phone Number