Wainscott

IIIIIIIIIIIIMIIIIIIIIIMIIIS
CERTIFICATION OF EXEMPTION
_7 FROM REQUIRING A CAMA PERMIT
\ as authorized by the State of North Carolina,
1✓ 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.
;ant Name f f-i -). VV fk is- .,-T-t Phone Number ''11°)•%Ntv. at
)ss ) 1 0v,c7.4A6, i..-Z State Zip
ct Location(County, State Road, Water Body, etc.)
and Dimensions of Project ;4.-t: 0 tat P i iL.E c� �,. R kiN LA. H L p
roposed project to be located and constructed as described This certification of exemption from requiring a CAMA pen
is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expir<
rent pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be nece
4 permit requirements does not alleviate the necessity of to continue this certification.
)btaining any other State, Federal,or Local authorization.
ETCH (SCALE:
1 i . I . _

l4 09 09: 34a mark Clements 910-270-9110 p- 1
509CJ 63,2ma 5co q 19 $41, - z�3
Letter of agent
I bOtAci 16.- VA C (( cOli- have retained Mark Clements DBA, Clements
Marine Construction Inc,to make application for any and all permits needed to start
construction on the work requested for our property or properties.
By allowing Mr.Clements to make such applications I do understand that this will in no
way relieve me of any obligations to perform all work according to the building codes of
North Carolina, CAMA,DWQ or any other state and or county ordinances.
D � — j /! • .Ai S~e-37
Pril
?�---
Si a�
ItW - `d1-kb - S date 12 . l9•Oct.
Contact information

14/2009 11:52 9197790826
TRYON BUSINESS CTR PAGE 01
14 09 10:00a mark Clements 910-270-9110 P Z
O
• ] C
NO
Name of Individual Applying For Permit.
3 � -
Address of Property: .s(Lot or Sweet#, &mei or Road)
44 6i - 2 ;-;Cyf✓'
(Cit)and County)
I baRby certify.1bat I own poverty ad e as shown angle .�mgthcdevelvpmeot
�'
applybog this iptionbas drawing,with sad be povided w�t is letter.
arc proposing. A
,/ alive no objections to this proposal
please write the Division of Goal
If yea ee 1 to t e� s, NC 28405 or call 910-395-31
Management,within 10 da7 ys of receipt of dais notice. No response is considered the same as on objectio
you have been notified by Certified Mal.
•
I noderstxnd that a pjer,dock,mooring pangs, breakwatm,boat horse or boat lift mns
set bck a minimum distance of I5' from-my area of riporiOn access-unless waived by me.
yO1u wish to waive the setback,you most initial the-approptlatu blank below.)
I do wish to waive the 15'setback requirement.
I lust wish to waive the 15'setback requirement
Sign Name • Date
a� Tv74er AVA

List of Materials to repair seawall.
78 pc 12' v-groove boards
6 6x6x12 pilings
6- 20' x 5/8 tie back rods
'/z roll of felt or backing material
24 bolts
9 4x6x 16 whalers
3- 2x10x16 caps
Repair work for
Mr. Wain Boyd Scott
713 Hughs Rd.
Hampstead NC,28443

ADJACENT RiYA.KiA-N
YKVYr,nl Z LJYV _
Name of Individual Applying For Permit:
Address of Property: 3 Hv 11.5 A
(Lot or Street#, Street or Road)
, 2
(City and County)
I hereby certify that I own propertyadjacent to the-above-referenceatproperty. The i d
applying for this permit has described to me as shown on the tacked bed provided with e opmc
a e rop A description or drawing,with dimensions, shouldpro
c
are proposing.
V I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of
Management, 127 Cardina
l Drive Extension, Wilmington, NC 28405 or call 910-3f.
within 10 days of receipt of this notice. No response is considered the same e as no ob j e
you have been notified by Certified Mail. ---
'WAIVER SECi'ION
breakwater,boat house or boat lift
1 understand that a pier, dock, mooring pilings,
set bck a minimum distance of ll5' from my area of riparian access
waived b3
you wish to waive the setbac ,you must initial the-appropriateb oe w
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement
Date
Sim Name

'onnect(il5 Page 1 of 1
4[ [01014...''9. +14j__-_‘1' .441
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