General Permits (889)

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CERTIFICATION OF EXEMPTION 1?--, 0 C
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 v -' Zip 2 J; W f
Project Location (County, State Road, Water Body, etc.) 17, P Z; x,4J C l ,n- Iri
Type and Dimensions of Project
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.
SKETCH
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE:
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Your project is subject to the NC Division
of Water Quality Neuse River Buffer Rules
due to its location within the Neuse Basin.'
Plelse contact Deborah Sawyer at rA ,
252-946-6481. ;
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.
Applicant's signature
i
i
CAMA Official's signature'
Issuing date
Expiration date
(.
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPTIRI\N PROPFR^" CWTIER ST ATENE: �J'r`
I hereby certify that I own property adjacent to
property located at
�j�_fie (lot, block, road, etc/`-
on // S ( f� in %%� I�
AI
(body of wat�� (town)
North Carolina in County. The proposal has been descrited to
me as shown below; the development, a)bulkhead/structure, and the
(circle one)'
proposed location, and I have not objection to the proposal. I under-
stand that if the development is a pier, it must be set back a mir.i-L-a
distance of 15 feet from my area of riparian access unless waived by me.
I do/do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by
individual proposing development). INDICATE THE SIZE AND LOCATION OF T'HE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND THE WATER.
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(Original must be retained in the inspection Department)
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OCT 2000
ADJACENT RIPARIAN PROP—^"_ C1JP�EL2 �T�Tc\1t\;'�
I hereby certify that I own Property adjacent to :- /, em
property located at /"flL,? _ LGT
__--��5 X%� (lot, block, road, etc /
on ni Li'C ee in / /V
( cdn of watr�C/i (town)
North Carolina in Count The /• proposal has been descried tc
me as shown below; the development, a pier,/bulkhead/structure, and the
(circle
proposed location, and I have not obiecticntothe proposal. I under-
stand that i f the development is a pier, it must be set_ back .a_ ni_ni.: u �_
distance of 15 feet from my area of riparian access unless waived ty me.
I do/do not wish to waive that setback r=cuirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by
individual proposing development). INDICATE THE SIZE AND LOCATION OF THE STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND THE WATER.
�+b'
LK
(Original must be retained in the Inspection Department)
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