General Permits (7385)

0CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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 .0203.
Applicant Name e R f i Phone Number M AZ • 8� 53
Address 5io ; l ,Fr 4 iPd
City �". State RIP Zip 2SC2..
Project Location (County, State Road, Water Body, etc.) 1Z Ad _J � j d -t # +
-,if ve. Cree f[ '�erorl -6cn ikafeoil 4'io 11`1.P 4019k .
A
Type and Dimensions of Project TT jool a boy., 4�e tJlAfG ,
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 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.
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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.
Applicant's signature
<
CAMA Official's signature
Issuing date
Expiration date
ui�gy;�s
Attachment: 15 North Carolina Administrative Code 7K .0203

L✓
MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PERMITTEE'S NAME: Eld;c #0 Wt it PERMIT #
LOCATION: Lof Wa/nai' ) late 'ra.1 d; vis"aL 1 5 �✓�� crfe K FIELD REP. J�a t,-
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pZ, Zov f
PHONE: 919- DATE REPORTEDLY COMPLETE:
DATE OF INSPECTION k - 2 / - o I
1) Do the measured dimensions of the development differ from those indicated in the permit and workplat?
YES/NO [circle one].
COMMENT:
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? YES/NO [circle one]
COMMENT:
3) FUTURE MONITORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? YES/NO [circle one].
COMMENT:

UNITED STATES POSTAL SERVICE
First -Class Mail
t Postage & Fees Paid
I LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
zc 'o � //6 we /i
510 M % Rd
14pe x 2,75-0 Z

t
ru
O '
mL SWANSMO K 28584
r-q Postage $ $0.33 ^ _
"-' $1.40 0503
CO Certified Fee
$1.25 Postmark
�p Return Receipt Fee Here
0 (Endorsement Required)
Q Restricted Delivery Fee
O (Endorsement Required)
O Total Postage & Fees $ 12' it %
FU
rU Name (Please Print Clearly) (To be completed by mailer)
m
Er -
or
r---Box N-ox.N------------------------------------------------------- ------
Street, Apt. No.; PO o.
Er-,
O----------- ----------------------------------------------------------------
City, State, ZIP+ 4
PS Form 38W, July 1999 See Reverse for Instructions
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
,355 ,1�YeeyY Po,,vi ��
Sw,j, ovo AX Cr
29150V
A. Received by (Please Print Clearly) B. Date o De ivery
C. Si ture
X tu Agent
Addressee
V • Addressee
D. Is delivery address different fro1? ❑ Yes
If YES, enter delivery address bel . ❑ No
3. Service Type
ET-C-e-r-ti-fie-d--M-a-]l--OExpress Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Num er Copy from service label)
-7 G`i'1 `�ZZO 9y-016PL-f.F/ Z�
PS Form 3811 , July 1999 Domestic Return Receipt 102595.00-M-0952

DIVISION OF COASTAL NL-kNAGEMEtiT
ADJACE.\'T RIPARIAN PROPERTY OW:, -ER NOTIFICATION/WAIVER FORA
Name of Indi,,7dua1 a 1 ing for Permit: PP Y� �
address of Property:
(Lot or Street r Strr:t or Road, City & County)
I.—Dy celdify that I own property adjacent to the aDove referenced propely. The indlti c�=
a_oiving for this permit has described to me as shown on the attached drwing the
-y are proposing. A description or drawing, wit
h dt,;,ensions, shouid be provided wrh
I have no obiections to this proposal
If you have objections to what is being proposed, please write the Division of Coa;al
Management, Hestron Plaza II, 1�1-B, Hwv., Morehead Ciz_v, NC, 28557 or cal r_
808 within 1 D days o recei t o this notice, : ' � �?, �� 80`
f P f �o response is considered the same as no objection if You have been notijzed by CerT Iced Mail.
WAIVER SECTION
? . de-stznd that a ier dock, mooring pilings,
p k p _s, breakwater, boat house, 1- or sand'caas mist
et ack a minimum distance of 15' i om my area 01 nparan access unless waived by me,
,a to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
S i gnature Date
P , Name
Telephone Number With Area Code

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PrOPe rty
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FOR -NI
-Name of Individual applying for Permit: �2 22r.4
A;]dress of Property:
Cyr,
(Lot or Stmet r, Strt-at or Road, City & County)
i e.'eby cei-airy that I own property adjacent to the above referenced property. Tne indi�i
ving for this permit has described to me as shown on the attached d:Qwiria the
-v a e proposing. A description or drawing, with di,;,ensions, should be provided
�r
I have no objections to this roDOsz
- P .
1f you have objections to what is being proposed, please write the Division of
Vanael rzt, Hestron Plate 11, 151-B, Hwv. ,Morehead Cuv, .'�7C, 28557 or call ' (' 5=) 808-
=808 within 10 da},s of receipt of this notice. 1Vo response is considered the same as no oojec��ion
if you have been notified by Cenijzed Mail.
WAIVER SECTION
1 :,ders�and that a pier, dock mooring pilings, breakwater, boat house, li-- or sandbags must c2
-. pack a minimum distance of 15' i om my area of ripat;an access unless waived by me. (Il vo_
to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback reauirem�!nt.
I do not wish to waive the 15' setback
requirement.
S;g:Iature Date
Print Name
� eiephone Number With Area Code

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ADJACENT RIPARIAN PROPERTY OWNER STATENLENT
I hereby certify that I own property adjacent to 66 /,P-
(Name of Property Owner)
properly located at
(Lot, Block, Road, etc.)
Q
on �rfG �j�l` t 1 ✓Gl'� , in �9-Y�c�YPi� , N.C.
(Waterbody) (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 DEVELOP_'VIENT
(To he JUIed in by individual proposing development)
Construct a stone (Rip Rap) enbankment approximately 10 ft from toe to top on about a 30 degree slope
along 100 ft of frontage along the White Oak river. Stone to be placed upland of CAMA stakes and be of a
size 80 to 120 lbs per CAMA requirements.
See attached drawing
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SigIfiature
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Print or Type Name
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Telephone Number
Date: (0 et. ;7 `f-, 2- z? 0 C)

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