General Permits (728)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
0 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 P �n� cj i-r : `1 ;, �H, t 4, !d
Address :5i io 4 01-4
City'
Project Location (County, State Road, Water Body, etc.)
Phone Number ?If3, i2111
State M Zip 76574")
S
Type and Dimensions of Project i ,pc5 t J ...< : c b"e %r A)II W
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 g0 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH Aft, • FS (SCALE: &ICIJr )
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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.
ignatdre
CAMA Official's sig
Issuing date
Expiration date
t
pit Mc A
Attachment: 15 North Carolina Administrative Code 7K .0203

CERTTFTED M A TT
FTT_', R F C'FIFT R () j ,ST. UED
DIVISION OF COASTAL h1.4.NA.GEME:tiT
1� ADJACENT REPARIAN PROPERTY Off^ ER' tiOTIFICATION/W AIVER FGP,%vj
Name of Individual applying for Permit: '-`�'•�1'i p {
Address of Property: a � ff.cxl4,B
(Lot or Street ", Saae or Road, City & County)
I hereOy certify that I own property adjaceit to a e above re:e;enced prope ty. The incividcai
applying for this permit has described to me as shown on the attached drawing the deve:come: t
=h'y Ve proposing. A description or d awing, Y4it;l e'ISI`Jr1S, Should be provlow V.': t}'t?c
Ie.�er.
I have no objections to this propes-a
If you have objections to wha� is being proposed, please wrzte tt:e Division of Coastal
�iiana�,�ament, Hestrori Piasu 1I, 151-8 Hwy. � More.ze;id City ,'�'C, 8$57
' 7 ? or call (F_) 808-
1808 within 10 days of receipt of this lzorice. ,N0 reu70tlSi 1� corstdered the Mne as no oci-on
if you have been notified by Certified Mail.
WAn7ER SEC'TIOy
I'-nderstar.d that a pier, dock, mooring piiings, bream��:e 1. :.
;e=. Lack a minimum d� boat house, ii., or sandba`s ;nut; ba
,stance of lS' from my area cr;=a- access unless waived by me. (I.'%ou
s to waive the setback, you must initial the apprcp:;a:e blank below )
--------� I do wish to waive the I5' setback red :ir.` ent.
I do not wish to waive the I:' se -,back re ,t; eTe,t.
J! Q:-ialiSr2
Date
lel)lx :Ire
Prnl Name
70� -- �ln
Te:e?hone Number W h Area Ccde ~-
r,-,-2 ro

LERTTFTFn MAIT RFTTJN RFC'FTPT RE
OLISTED
r�
DIVISION OF COASTAL MANAGEMENT
U) `h ADJACENT RIPARIAN PROPERTY O W-NER .NOTIFICATION/WAIVER FG Rti1
Name of Individual applying for Permit:
Address of Property:
p
JUf 1�
(Lot or stre,-; ' $tree: or Road, City & County)
I hereby cer-airy that I own prope,,-ty adiacent to the above reverenced prope.�y. The individual
zoplying for this permit has described to me as shown on the attached dewing the deve:oo,,,e;,t
''I"; a-e proposing. A description or drawing, wit;; d :nensions, should be provided w -h th;�
er.
I have no obiecdons to this propos-al.
If you have objections to what is being
I roosep P '�, please were the Divisors of Coastal
'Went Hestron Plat I-.
�Ianage. ,
24, MoreGu
head y, NC, 28557 or call (252.) 808-
2808 within 10 days of receipt ICIB> Hwy. of this notice. No rernoRsr is considered the same as no objection
it you have been notified by Cerzi ed Mail.
WAa-ER SECTIO-i
I _:,de stand that a pier, dock moo Q piiings,
orn- br,�,.,a_ .. boat !lit or
back a minimum distance of 15, ._ _ hoLse sandCa_; m::st be
iiom my area of access unless waived by me. (T-
vvah to give the setback, y
ou must initial the approc.,ate biank below.)
I do wish to waive the 1 5' setback rec ;r= �nt
I do not wish to waive the 15' setback r ec irement.
Je
re
Da
Pa�-Name
Telephone Number With Area Code

y6u
�-e-
40

I hereby certify that I own property adjacent to ,, 4Z-e7-V Z66:h17clz )'s
(Name of Property Owner)
property located at J"!Q 6114Cf/i C•C GC,G ZV
(Lot, Block, Road, etc.)
on 6VIS o&1-,,�I) , in 621,11vi , 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)
M
-Hoc-? u e Sa Vel
6 A-
•o'� S eC+0 tt 014 e
�c�ur �ou� 61 t (ub
Siznature
/��� C2F-
Print or Type Name
Telephone Number
Date: '/'-, - % 0/