General Permits (896)

CERTIFICATION OF EXEMPTION' ►
FROM REQUIRING A CAMA PERMIT �J�
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
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
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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 River Basin.
Please contact Deborah Sawyer at
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.
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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Applicant's signature
7
CAMA Official's signature
or
Issuing date
;
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

03/01/01 14:43 FAX
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Customer Job Requiretment Worksheet
Customer Name��'Z�� Date
Mailing Address 1c1J,L-�_Job site Address a
phone# 'o -QSj Fax#
Adjecent property Owner
Leis side
Qi al t�c).
Date Mailed Returned-3 - I - 01 Date Mailed
Cert. Mailed
Returned
State
City
County
Fairfield Harbour
Bulkhead
Dock
Boadift
Jettie
Dredge
Cert. Mailed
Permit Required
Job Type
Recived
Recieved
Recieved
Recieved
Boathouse
Jet Ski Lift
Ramp
Repair,
Returned,3 - j -0 1
Returned

03/01/01 14:43 RA-1 (o 002
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby cent fy that I own property adjacent to - ' 2. r I . - i -L A 's
Name of Property Owner)
property located at
(I,ot, Block, Road etc.
v.i m , in AJ Ed Jrjft 0&9 g;j . N.C.
(Waterbody) (Town and/or County)
He has descn`bed 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)
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Print or Type Name
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Telephone Number
Date: o
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03/01/01 14: 4 3 FAX QJ03
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