General Permits (8102)

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CERTIFICATION OF EXEMPTION 9
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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 li %�i� /' �'y%�`l Phone Number dam'
Address
City 17, State. Zip
Project Location (County, Stale Road, Water Body, etc.)
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Type and Dimensions of Project �� C' It r r' /,- e F
The proposed project to be locafed a4 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.
I SKETCH (SCALE: J
Any person who proceeds with a devbi)pmtnt 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
velopment.
t
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
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Issuing date l
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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FIELD BOOK
DRAWN BY
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RECEIPT FOR CERTIFIED MAIL
NO INSUPANCE PPOIDEO
PoOT Fj. ATENNAiiuNAL MAIL
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Special Delivery Fee
Restricted Delivery Fee
Return Receipt showing
to whom and Date Delivered
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CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Dear Ma 4ur,yry
This letter is to notify you as an adjacent riparian landowner of
Mr. /Mrs. M 9 )S6WWELUZrt plans to construct I A%PLK i4,r D
A O PE 1tz
on their property located at 1 1 ) w%I / Fi. cA` 4 Lug 5-S
in ST,=LLA NC. The sketch on the reverse
side accurately depicts the proposed construction.
Should you have no objections to this proposal, please check the
statement below, sign and date the blanks below the statement,
and return this letter to: G� 12 /�� / ��yL LOL2
P o (3a 33 A/FwPcrci /VG sS70
as soon as possible.
Should you have objections to this proposal, please send your
written comments to the NC Division of Coastal Management, P. O.
Box 769, Morehead City, NC 28557. Written comments must be
received within ten (10) days of receipt of this notice.
Failure to respond in either method within ten (10) days will be
interpreted as no objection.
Sincerely,
I have no objection to the project as presently
proposed and hereby waive that right of objection as
provided in General Statute 113-229.
I have objections to the project as presently proposed
and have enclosed comments.
2
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Signature
DATE: 7-� —

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
-TP'c SE✓✓ L©,6 's property located at
(Name of Property Owner)
co lI Sic -A /aa wyl%i. C,9/< P'zuF",�s 01
(Lot, Block, Road, etc.)
on w14176 66K r21119d in Cs4�251�:=mot;= i �'��N�✓ 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 DEVELOPMENT:
(To be filled in by individual proposing development)
Sign ure
Print or Type Name
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Telephone Number

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GENERAL PERMIT APPLICATION INFORMATION
APPLICANT'S NAME: & A n y V/' U L M L I S NIA/ L" L. D L _ I
(First) (Middle) (Last)
&ING ADDRESS: /% O A K 6 L v J-'j` S -- Q
(PERMANENT) _
S lL LL_A STATE // G ZIP 9L8 S 9�
TELEPHONE: WORK (y /q) '�� G — s :s'/ HOME ( yam_) 3 —c-I59,10
CONTRACTOR'S NAME: M4 rI ✓I ni l /- / 12--i✓ TELEPHONE NUMBER :3 9 3 7 F � S�
PROJECT LOCATION: N.C. Hwy. # S-K SR # I 1 0 Road/Street Name (3L u z,f: Dq !y;_
Waterway Name (-v1-1171-; oqK County CAt2Tiktr %
Town S%L LA Subdivision w1-j17C c),qK j�aLvf�S
PROJECT ACTIVITIES:
PIER:. Total dimensions of pier from MHW to platform
(Length) (Width)
i
'T' or 'L'-head platform a
(Length)
Water depth at end of pier -3
* HOUSE/BOAT LIFT:
BULKHEAD: #1
#2
io
(Width) (Number of Moo Piles)
Number of Mooring piles
, L//
Length IV 4 Width
Number of Piles Water Depth
Total length
Average distance waterward MHW
Maximum distance waterward MHW
Total length
Average distance waterward MHW
Maximum distance waterward MHW
RIPRAP: Total length Base width from MHW
EXCAVATION: [MAINI'ENANCE 'ONLY']
Length Width 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 Hydraulic
OTHER STRUCTURES: