01644D - Simmons

IPA
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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
01.
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K Z;Q�
plicant Name 1 Y\ Phone Number �(J
dres!,,,k - I-) PI -A '1 -1
Y
Dject Location (County„State
rV ((i"
pe and Dimensions of Project
Road, Water Body, etc.)
proposed project to be located and constructed as described
✓e is hereby certified as exempt from the CAMA permit
iirementpursuant to 15 NCAC 7K , r?, . This exemption
:AMA permit requirements does not alleviate the necessity of
r obtaining other State, Federal or Local authorization.
State
Zip
This certification of exemption from requiring a CAMA I
valid for 90 days from the date of issuance. Following ex
a re-examination of the project and project site may be n
to continue this certification.
KETCH (SCALE:
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o�eS
J FOB °2 q Cyr \\ °� Aq ,�o Qlo 4/�
1
f R, SIDEWALK
/0
1� O �' (1` EDGE OF PAVEMENT -
1/0
I
7-T-1111 I

-LAMA / ❑ DREDGE & FILL _
.tNERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
.oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �y '
�� � F�Rules attached.
t Name / st"s dt 7 . Project Location: County
Street Address/ State Road/ Lot #(s.) A%,4
#.Z, A,4 State s' "'r: ZIP
#( )
ed Agent
❑ CW ❑ EW €7 PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH �Z UBA ❑ N/A
❑ PWS: ❑ FC:
Subdivision
City J �`i LAG � ZIP 26 S
Phone # ( ) / River Basin
Adj. Wtr. Body SIJ d -E' XI Ve'4 n—at
yes / no;' PNA yes /` no Crit.Hab. yes / no Closest Maj. Mr. Body t�
' Project/ Activity
:k)length
i(s)
ier(s)
ngth
-nber
t
i/ Riprap length
distance offshore
x distance offshore
iannel
)ic yards
ip
se/ Boatlift
Adozing
a Length'{
not sure yes no
is not sure yes
ium: n/a yes no
-'yes no
(Scale:
SIDEWALK
EDGE OF PAVEMENT
S"rg!
kttached: yes Cnno,
ig permit maybe required by: Aei i I ' _ i9((
fr' d a n i i r k
❑ See note on back regarding River Basin rn