General Permits (839)

I
r CERTIFICATION OF EXEMPTION
_Y 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 Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
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.
SKETCH y (SCALE: )
c i-1 Al-,
i
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signature + I
development is exempted, will be in violation of the CAMA if there S
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
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.
Issuing date
Expiration date
i Attachment: 15 North Carolina Administrative Code 7K .0203

jo
..
ADJACENT RIPARI-tN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Jorr 4- d-cc 4 Ko I ki,,is 's
(Name of Property Owner)
property located at
A, Block, Koad, etc.)
on 9oarre- sooA)d , in "CMtA'9/01 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. I understand that a pier/mooring
pdings/boadift/boathouse must be se: back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to wai,,-e the setback requirement.
I d2 wish to waive teat setback requirement.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEVELOPtiIENT:
(To be filled in by individual proposing development)
(A) A 60khFAD +1r)e poqucc of Shoe—c- .tie
3Q I kA--,-7i b s hA 11 bC-
t-i i.�1RTC71- m!�n� 1448 M.e� � � srN
ll�� T� CG.ntS� IL�u t� A pl o-L— 1 aC 1 Lj�N(. X 5' LU i e J� w ;�-tl �1 .257
Cjj �f Erb, ThE Dice- --5;hALk- A+ -fhC CEk;+ELc
Nd e0 GN ® i U'r'r-> YU"J8
Signature
I S I -�' /s � J '—rs
Print or Type Name
(-70 3 17 2> S8
Telephone Number
Date: A `R �o c�

YhIt•
Da It
IIvor,
'•t•`
� E�vld
9°q�•
s'Und S 64° 14' 25"E
17. 45"
QC�°n
AEI°n�,a
�aa•;t° a°' SITE
o�+
51
N 740 40' + 2," E
N 69e31' 29'E
19. 82'
Ex. Iron Pipe
Ex. Iron
7
50.29' Pipe
VICINITY MAP \ _ —!�ND
Not to Scale
Ex. Iron Pipe \ \ Natural Area
\ 4
28,
14
a 0) 16 Bi- kf--Porch,-'
� — ��, I8 --Dec, /G �
26
rn 3 \ \m ) I r 28 w
28 j % l c6
M 5 \ 26
24
(V ro to '� 22 24 _ 0 0►O
O v ` it8i 18I \ 22CU
p
Town of Emerald 2 20to
Isle CAMA Setback z/ Proposed Dwelling
LOT AREA \ 18
12,598 Sq. Ft. — — , 0 \
52.0'
16.9'
-----
NATURAL AREA / `O 2 reps � i I m
5,725 Sq. Ft.
45.4x
IMPERVIOUS AREA
\ z
Dwelling - 2,614 Sq. Ft. _ _ _ 8 30, M Bldg. LIn
Porch - 192 Sq. Ft. -
Driveway - 342 Sq. Ft.
Total - 3,148 Sq. Ft. / \
Proposed 1.71'
24.99x Ex. Iron PiWIde Conc. Wheel \
Pe Paths With Gross Ex. Iron
V Area Between \ gi Pipe
NOTE: 5' RiW Easement 8\ 41
10' Utility Easement Along
Street R/W -119 Os, 3
� o \ p�3
1
Ex. Iron Pipe A=30. 77` S
0 6" or Larger Tree R - 40. 00,
Ex. Iron Pipe
op
NOT FOR RECORDING pwvs
"TIE" Private R�
P. 1. N.: 5373. 12 96 1909 S 26005'51 "E 40.03' `p,0 ip
FLOOD ZONE: AE ( 10' ) to Ex. Mag. Nail
SUED. REC.: Apr I I 1991 PRELIMINARY PLOT PLAN
Lot Within 575' ORW Line SURVEY FOR
20 10 0 20 40 CECILIA HYMAN KOLKIN
GRAPHIC SCALE -- FEET TRUST
I, Pate D. Phillips, Professional Land SI{r<aAjbf�ttttr�i�� Carter e meraltdCounty REFERENCE: Lot 20
hereby certify that this map was dn*w Tior�RO "o North Carolina "ROYALL OAKS' Blk. 46
supervision from an actual survey�rla LQder• Z/ y Map Book 28 Page 229
my supervision; that the ratio of$re�IsOESS/6•;2.9'� Scale I" = 20' Carteret County
calculated by latitudes and dep&tureg* ls� 2 L Oct. 16, 2000 Registry
1_/ 10,000 + _ that this magi � as Lie d 9r
In accordance with G.S. 47-3Qas api de�,-- PATE PHILLIPS and ASSOCIATES, P.A.
94-0
WITNESS my hand and seal this 4� f_, S
- - P.O. Box 214
PLS No. L-2640I. .• S� `: Swansboro North Carolina
----------- ^} Project N o. 99 —15 7

ADJACENT RIPARDN PROPERTY OWNER STATENIEN'T
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to -.! r.l d Cj'-eb,,q %E I k„J 's
(Name of Property Owner)
Property located at L p t ..2co L,I k. c',>.� 1 GI L S0S d , .,',s c)tJ ,
(Lot, Block, Road, etc.)
on 9c)6 t1' .S�,twj , in jFM grg'gl al ._Ts % , 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. I understand that a pier/mooring
pilings/boadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I dii wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
bol k%,)enb ,a- 4c p�(Zpcsc z+ sho 1►�i
WNT1� Mo2k Auci jci,a C)4srJ.n1C' L"t i4.,. 1 •
C13) T-c- A pi 12 I C c' x 51 w I DC
-T-CI �T . Tk e pica- s l')A 11 !j- c Q .4 A '�' * c C -I-E7z-� ►.u" F r: rt
Signature
J
Print or Type Name
Telephone Number
Date: i 0 -) I �200

a
Vh It•
Oak
liver BO .�
co' �n N 69031' 29'E
` Or
Ems aid Dr. Cryo19. 82'
tiJ jJ
sourd S 840 14' 25" E Ex. Iron Pipe
go9 17. 45' S 7 Ex. Iron
a��an
Pipe
4 E
cooat e SITE N 74a O' O .�
VICINITY MAP
Not to Scale
Ex. Iron Pipe \ \ Natural Area 20
\ l 4
\� 6 / \O
2I �� f 8 ✓/� /
to
28
16 y --,-"Porch/
--Deck" _ et
26
28 \ is 28-W
26 1 n o
24 O
o e' 22 24 — 0 M
N
Town of Emerald 2 g 20 ut I
Isle CAMA Setback Z/ Proposed Dwelling
LOT AREA 18
12,598 Sq. Fit.
52.0' �
(By Coord.) t 16.9'
NATURAL AREA / 2 �\teps I o
\0
5,725 Sq. Ft.
45.4'/. \ �o
IMPERVIOUS AREA z
8 ---
Dwelling — 2,614 Sq. Ft. _ _ _ 30 Min. Bldg. Lin
Porch — 192 Sq. Ft. o— — —
Driveway — 342 Sq. Ft O \
Total — 3,148 Sq. Ft. Proposed 1.7I' `r
24.99i We Conc. Wheel
Ex. Iron Pi \
Pe Paths With Grass Ex. Iron
Et Area Between \ Pipe
NOTE: 5' RIW Easement 8 \ 41 +�
10' Utility Easement Along Sao ' 6 36
Street R/W 39 OS,
Ex. Iron Pipe A-30. 77\ CO
0 6" or Larger Tree R - 40. 00'
14" Ex. Iron Pipe
�} BERA>
NOT FOR RECORDING
P. 1. N.: 5373. 12 96 1909
FLOOD ZONE: AE (10' )
SUED. REC.: April 1991
Lot Within 575' ORW Line
"TIE" / �O 111?ivp ;.t"
S 26005'51 "E 40.03' ` c; Private H.,kJ
to Ex. Mag. Nail
20 10 0 20 40
GRAPHIC SCALE -- FEET
I, Pate D. Phillips, Professional Land'4OtWA ietrt��jr0,i
hereby certify that this map was ��t�o d O� 0.,
supervision from an actual survf'� e,(vs� •." I/f� �ii
my supervision; that the ratio it pricrs(gii s 02•�9
calculated by latitudes and de#arturees 9
I i 10,000 +----- that this triap waC-jE4bredr ;
In accordance with G.S. 47—k as Orendec'640 Ir
WITNESS my hand and seal INS, I . of 0�'T
PLS No. _ L-2640
P ..
PRELIMINARY PLOT PLAN
SURVEY FOR
CECILIA HYMAN KOLKIN
.'RUST
Emerald Isle REFERENCE: Lot 20
Carteret County "ROYALL OAKS" Blk. 46
North Carolina
Map Book 28 Page 229
Scale I" - 20' Carteret County
Oct. 16, 2000 Registry
PATE PHILUPS and ASSOCIATES, P.A.
P.O. Box 214
Swansboro
North Carolina
Project No.99-15(