General Permits (7206)

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Y
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
• as authorized by the State of North Carolina, g
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern _pursuant tg 15 NCAC Subchapter 7K .0203.
Applicant Name
Address _
Citya ,�� �•�
Project Location (County,
Type and Dimensions of Project
Road, Water Body, etc.)
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.
Phone Number 2 6-� T�
State ,"4< C _ Zip,211-II&I
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.
SKETCH ( —/-- -) (SCALE: )
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.
licant's signature
CAMA Official's signature l
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

41�

F
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
��o"('D " A-
+Clv 's property located,. at
(Name of roperty Owner)
(Lot, Block, Road, etc.)
on �U , 11 , in glf)e rA N J�A _- N.C.
(W erbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
i
CI_r
Signatur'
IA
v�
Print
Type
Name
7 c° 2—
-(—'2 2— 7
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Poole- s property located at
(Name of Pr perty Owner)
(Lot, Block, Road, etc.) %
on �D a -Sd aAlc , in o' `Cif
e=LTS/C N.C.
(Water Body) (Town and/or County)
He has described to me, as shown below, the development tie is
proposing at that location, and, I have no objections to his
proposal. Jam% o
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
L L)
Signature
Toter elf
Print or Type Name
?/- <i`y�
Telephone Number

GENERAL PERTffT APPLICATION INFORMATION
1 �
APPLICANT'S NAME:
• LING ADDRESS:
� r�cr�nNKtv'r) i
STATE ZIP
TELEPHONE: WORK HOME ( ) 1( 6
CONTRACTOR'S NAM. TELEPHONE NUMBER
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PROJECT LOCATION: N.C. Hwy. �/ ,! � SR 4i Road/Street Name
Waterway Name County
Town�,,.�„�% ,(�.� Subdivision
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
'T HOUSE/BOAT LIFT: Length
�BULKEIEO 111
112
Number of Piles
Total length
-t-
Average distance waterward MHW
Maximum distance waterward MHW
Total length
Average distance waterward MHW
Maximum distance waterward MHW
RIPRAP: Total length
EXCAVATION: [MAINTENANCE 'ONLY']
0
Length Width
Number of Mooring piles
Width
Water Depth
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
Dragline
OTHER STRUCTURES:
Mud
Backhoe Hydraulic