General Permits (8165)

CERTIFICATION OF EXEMPTION � �f
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 pur uant to 15 NCAC Subchapter 7K .0203.
Applicant Name-- 4
Address L2
City
Project Location (County',
Water Body, etc.)
.90t,0' Phone Number, �,e$
State . C Zil
Type and Dimensions of Project /-?
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE: ) I
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
10velopment.
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.
w•�
Applicant's signature
CAMA Official's s� urg
,b Ze"
Issuing dat9 /
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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STATEMENT OF OWNERSHIP
general n
I, the undersigned, an applicant for a CAMAN:]mxdevelopment permit, being either the owner of property in z
an area of environmental concern or a person authorized to act as an agent for purposes of applying for a CAMA
minor development permit, certify that the person listed as landowner on this application has a significant interest
in the real property described therein. This interest can be described as follows: (check one)
X an owner of record title, Title is vested in Ballou Enterprises , Inc . to South Shores
Map
Homeowners see MMX Book 27 ,page 117in the
Carteret County Registry of Deeds. j
an owner by virtue of inheritance. Applicant is an heir to the estate of
; probate was in County. j
if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that
I have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA nrrmit
(2)
(3)
C. 28412
7
i
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE SHORELINE EROSION AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area which may
be susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the _
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
concerning stabilization and flood -proofing techniques.
PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
t
This the 14 day of February , 19--u.
Land Owner ,)r person authorized to act .,s his agent
"ar rurpose; of iline a CAMA application.

GENERAL PERMIT APPLICATION INFORMATION
Richard D. Hail,
Ballou Enterprises, Inc., Developer representing
AppLICANT'S NAME: South Shores Subdivision Homeowners Park and Water Access Area
(First) (Middle) (Last)
Mh 1NG ADDRESS: Post Office Box 900
(PERMANENT)
Morehead City
TELEPHONE: WORK ( 919) 7 2 6 - 6 811
CONTRACTOR'S NAME: T. D. E u r e C o n s t. Co.
PROJECT LOCATION:
STATE NC ZIP 28557
HOME ( 919 )
247-7410
TELEPHONE NUMBER 728-4191
N.C. Hwy. # SR # 1177 Road/Street Name River Bluff Road
Waterway Name Newport River County Carteret
Town Morehead Township Subdivision South Shores
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
BC. HOUSE/BOAT LIFT: Length
Number of Piles
Number of Mooring piles
Width
Water Depth
BULKHEAD: #1 Total length 75 Feet
Average distance waterward MHW none
Maximum distance waterward MHW none
#2 Total length
Average distance waterward MHW
Maximum distance waterward MHW
RIPRAP: Total length Base width from MHW
EXCAVATION: [MAINTENANCE '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
OTC STRUCTURES: