General Permits (911)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
-Y
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 to 'x E' � ,�t �•.
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 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.
SKETCH f; _ 1 1 r `L (SCALE: i )
1�:�`: &1:�'t</C_ �'t"t:'L I.
—
'.tIY1tIA� Q114 !?kiI u'j) bt e(tov, �*°G�_ b a -bay /}wi c1 k
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�y��;iPt �H�'�!t f,(.(�f'S•C-U�'. r ` �t'^'^`Nt:r�f'ru�C�1 �.YC�C .•�.i
T�
t
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f
�.... .. .,h.. ., .,A .„ifh oAl nlnn monf withnnt tho rnn_ _. 4 it'Y a'1 �L+i •i':�:-.,�1.`Fr
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 !:
CAMA Official's 'signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

AUG.17.2OO1 12:OOPM CRMC CARDIAC REHAB 252 633 9972 NO.191 P.1i4
t
Craven Reglonal Medl(;al Center
2000 NeuSe Slvd.
POSt Office Sox 12157
New gem, NC 26560
office 252.633.M09
Fax: 252-b33-997'?
TO: ` (/Zi ���J , From: �J "
Fax: Pages:
Phone: Date:
Re. CC;
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
9-W)11710r-�
Note- 7his information has been disclosed to you from records ,Nhose ennfidentiallty is protected by
rederai law. Federal reeulation (42 CFF Part 2) prohibits you from making any further disclosure of It
without specific •Nnrten consenr of the person to wham it pertains. or as otherwise permitted by such
regulations.

AUG. 17.2001.;;,.•-12:OOPM• :a,. •.CRMC CARDIAC REHAB 252 633 9872.�;•.0 :4.
;••�. ». M0. 191''ey" '14 P.is
2i4`
i°�r�y �.. ail.�Y.'LiKc H :>.�;, a.i•. '1' i� ..� :J;:'% r;cu ); .i :•� _v.r.'.ti„i!��17• 4 '��..•L• 'r�1'R; i-.��%4•
�� + ��, .��, ^Y� tl`�t• a;t�';!�Vi'id •�'ri aSo��"''i'• s �"-:c._:�. r I•A 1 t e•:�1��•ai l " 6 ;��� If� �,!•�.
9 Tad �+;, ;i'' ;;����j�' — "�' t M kbj• � W Y.,1' k:�_l".�` •'��i::itf�'Y�"a..r.�.. �,.� L . i 7�•'.�n�,}I,�i� r��l'
die' i'RQPER-TY�',,O.
ETA '•:,.: ,,
• .Irlti� •Ns ���. a,�. N% •nn'r..� ,,�^ i ,
`�i. i �,iJ, •�w, ^.^� •v }F:" �c'::,��. rCL;•�t�l,L+.,:: rai�;': ,
PI I�IJt�01�f !� PfI1NGSMOAt . r/8(A
T hereby'oatiFy that I own property a(rjat:att to _ harn r
(Name of Property. Owner)
propeny locawd at t- ,S
n / (Lut, Block, A d, etc.)
on.l VDrlfp� , in , N.C-
(Watt:rbod}) (Town Andlor County)
He has d=n-bcd' to me, as shown below, the dcveiapment he is proposing at that
location, and, I have no objections to his prcpvsal. I understated that a pier/mooring
pilingaboa0 t/boadmuse, most beset back minimum distance of fifteen feet 051 from Tny arr..a
of riparian access unless waived by me.
I da 13at wish to Waive the setback requirement,
Y d,Q wish ro waive that setback requirement_
DESCFMMON AND/OR DRA�VLtiG OF PROPOSED DE`'ELOPIMEN
r7o be filled iA hs whfd'ual pmsposirrig deveLopmeRQ 1
war -ord � !
joal4e iJL
31�� JkL Pm'�qdi6 ek/ tnfr . ......
Ono( LO-111 mae:� te rrs
back
Z62.- (3(o 3q Y 7
Telephone Number
Date: .S b
T-d brLe-6'bZ(aS27 QUTPWax[3 uoQ
d01 : LO L Q Sq t'ri'C'
r

AUG.17.2001 12:01PM CRMC CARDIAC REHAB 252 623 9872 N0.191 P.3i4.ri
"srA,.,;.
" ---(FOK,,�I PIERYbIOORING PJUNGSIBOATUFFIBOATHOUSE)
...... - I'I� t • . _ _ __
i hereby certify that 1 own property adjacent to gMri M, i5l,'S
(]dame of Property Owner)
property located at Q - r S
n / 4 n' (Lot, Block, R d, etc.)
on /VO (.1 , in N.C.
(Waterbody) (Town andtor County)
He has described to me, as shown below, the development he is proposing at that
locagon, and, I have no objections to his proposal. I understand that a piertmooring
pilings/bortliftlboathouse must beset 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 & %%ish to waive that setback requirement.
DESCRWnON AINVOR DRA1NTM OF PROPOSED DEVELOPMENM,
(To be fiffed in by individud proposing'deveioprneat)
ash OPp rtJ�fsdedy 8p- i n le
IP : �r 4e, r Orr I
. Jtxa
a(A Will ftdi:'
�9
---------------- -------- ------------- ---- -----_----_-------- ---------------------------
i
Print or Type Name
F -�f-/947
Telephonc Number
Date:�-
T'd LE- 6ip.ztz9Z1 ,auzpuoxo uoQ dOT-LO TO 50 Tnf"

AUG.17.2OO1 12:01PM CRMC CARDIAC REHAB 252 633 9372
I
NO.191 P.4/4
■ Complete items 1, 2, and 3. Also complete
i
Item 4 if Restricted Delivery is desired, ,
I IN Print your name and address on the reverse
sc that we can return the card to you.
■ Attach this card to the back of the mallpieee,
or on the front if space permits.
1, AR/lloole Addressed to: Q
2. AM
(Tn
PS Ft
* Complete Items 1, 2, and 3. Alto complete
item 4 if Restricted Delivery Is ciesirod.
■ Print your name and address on the reverse
$o that we can retum the card to you.
■ Attach this card to the back of the mailpiece,
OF on the front if space permits.
1. Article Aadre59ed to
/d%s le f1�i7�
ON n
A. Recel ed by (plonsPrfnrCiearly) B. De of Delivery
I-- 1 7
C. Slgn re
X ❑ Agent
Addrwigae
D. is delivery fferent from item 1? ❑ Yae
If YES, ,Q� ess below; ❑ No
�] COrti�7 teas Mall
/❑ Registers Return Receipt for Merchancilse
❑ Ineu(ed Mail I] C.a.D,
4. FeatHicted Delivery? (Mara Fee) ❑ Yes
1t72fi96•o1�4-1424
A. Redeived by (Please Frith Clearly) S. Date of Delivery
C. Sigr�tu+re
eagent
D. Is dollvery sderess dlffereni from Item 17 O Yes
li YES, onter delivery address below, ❑ No
3, R,'
rvIce Type
Certfile Mall ❑ Expraea Mafl
c,,.istared ❑ Return Receipt for Mmcnandise
❑ insured Mall ❑ C.O,D.
4. Restricted Delivery (6rtrn Fee) ❑ Yes
2. Article Number
(Transfer from service label)
PS Form 3811, March 2001 pomeede RMLum Recstot V ozOsss-ot h �a

08/17/2001 08:09 2527457067 BUILDING INSPECTIONS PAGE 02
JU 24.2001 10:59RM .CRMC C,PRDIAC REHRB 252 G33 9U?Z N0.019 -- P.3/4- - —
4 _ .;iri' ,' -A i R�ARL4N i'RO�PSRi'i� OVKNER S'i'Alli`N�:' r ,
• - .��.,� rraw�o�Ow�Ga�TUFr��ai�ttiortsq-, , -t, ;;,,.
-.. Ina r;�►kl . � �....._ ,
• r booby ccnify that I mp popmty a 4me nt on •:
(Num or Pr pmly Owvier)
prropany WOW IL AdA= I&A4 PU -,I af' al -.SA r„zSAA ,
(Lot, BWd4 RmW, elc-)
(Wd rbod i (ftwx sewer cmay)
He has deW bW to me, as shown blow, dat dt vckgm ht he is proposing at that
bcation, 34 1 FWft no objwom m his proposal, I vadarsWW that a pier/mooring
ptlin jLgmWft/baatbausz rnrsfrom my am
of dpwirn Mess unless waived by ow
-
I do not wish to waive the setback nquimmcm.
,_. 149 wish to Waive that setback .aryl,
DF qCKUTMN ANDM DRAWY.niG or morosm DEw*'ELOT,%fv4rT: .�
rTo be h7l�d i>K by raaviafdiad r+spsi�� darew�Dtrae+h)
owo-6"fei, 004 in Itn9�h
41y, t,ial�r ord ray a
JkG m tddle, o/ our J ob-, !
OnO< wi rnei;"
�4,01J &Z-1e,
Mint or Type Name
TeleprWw Numba:r
Out: d 71aF1-Z
t 'd �tLt:-BtiacaaZa ,syTpuox0 -101 -1.0 10 so inr,

08/17/2001 08:09 2527457067 BUILDIi!(-7)INSPECTIONS PAGE 03
3Lll_.24.2901
CRMC CIWD 252 6PJFJNaVBOA
WS
►
iikr. ,. .� ' tii i a•Z..� !K..
.ate.. . '��-.: .,,'1`,-' ..a,., r', ,attar •`.. �?� ` ;�•;r. +.... " ,' ,. ..
- T tia+eby'W* plat C ow11 yeo/eeq► 44mm 10
(NWW or propaly, Owner)
> Jx Wood at S��Q Q 4Po.,L Pd Ijol - ArA t-As A A
i .. , � qa, sue, �'
a' 'JA l ekk _ . k -#i�W - - N.C.
lit bms doscn5d w mr as &own bobw, da deviapmm be is pmposinj at ftl
bcatM, WC I bm no objecOm 10 Ms p WNW. I W did Oat a pieri lood"s
mou belo bwta dobl m - disWAz Gf r b m toot (15') from my arm
of 6pain omm anlesa w4uvod by sie.
I do Wd wish la r ldw the setback topbwamt.
I Am wish m waives dwe ss 1 F!, iglus t
D SOMMON ATOM MUWI NG Or MOT*= DO"ELDFUTN r;
Rb bs Jple+�' is 4 "W69WINVO if 00"48Fwr1102rt)
Wal�rordo4l
3%-� )P L m tddle. o f cur
' /moo( �� l l ,�,:.c,� r��sx:4►+e
2 �z-Lae - ./ 7
Tdqoom Her
»48--
i'41 OT4-9-s*Rt8L2] OUTRUOKC ueo
dol =Lo To 90 LnT+

I
^/er JI
//; /Z
e 515 / //1
� P 5 i T%.��'' •;=_ � � Sys .

i7'_>c_ o-_iz) ::,P I
OF)r7T'O.'VVNER,_`,. "CEN77""'
P4
V NG PZUA%__, ?ATLIFTIBC4,
T. iterehi y that t Ow- .y ad3acca tc i
(Name of Property. owner)
(Lot, Bladl, Raid, C(C-)
!l . e N.C.
(Walabaft) (Ta%cza anWar Counq;
N- "m descn-bed to ^ as shown belcr- the developmen, is proposing of Iha[
location, I have no Baas to his I UndcrS .-,;at a pier/moor
pjlings/bmjjjftA=Moaw must be5v. backa minimum distance affift= feet (.15') from my area
of tips iian accer- -_inless waived b,.- -
I do not wish to %'Mive the setback requirement.
1 .42 'Aish to '­' that setback TCC,* _l' i -=U=L
DFSC AND 10. 1 . I - MG OF r DENT'.
Mo befllW,'* AV individudpmposing development)
e
cvr
ano( Q111 1"kt-
Priu or Ty* Na=
Telephone Number
0 14-E- G*,2 C a$2 i OlOT ;1-0 Tnc-

Jul-'C�01, 10: 59A1, _RMC CARDIAC 3 252 633 9"
s;
RIPA -N PROPER Y OVIVNE ' STATEI��NT. i
D.p c ,., �.. _...
AT. US%' _ ( NGS 80�4 T � HO ,
t !rc*e •afy that I ow, Lay adja=t to Y' a
Name of Property Owner)
nroWrty lrxated a�' r ..7_,
,,/ l (Lot, _ . zx, Roid, e(c.)
on /VB ��T . w.� in ��°!r N-C-
iF (1 - ' :dfor County,
Nr, has described to me, as shown below, the development he is proposing at that
-a7, and, I cr objectiems sal, r : -stand that a :r/moorin
Prof° g
p;..,as/ba tlift/boatt� �c must beset back a minimum distant of fifteen feet (15') from my area
of riparion access unless waived by mr_.
a nod wish to w,..:c the setback requirement.
"a waive that requirement.
DFZCRT'-10N ANM101" " '-AT G OF C "`"!;ED DEVE". -`�'T:
(To be fllfrd y ifvdMdual propod-;ng derelopmertrl
��S r' �P ��X� �►a�'� i y
`t, �' Ord 10 i
E- V L act ,1�; ►- =a {i ; n
�-34=I _ 3 --� � Jvt iC�G�(�• �^ ° �!_ � off.
anot u i1 (egc&,1!wrvr4
'L+ �b-Cr _.
Signacu:
Print or Typc Name
-- /
Te1ept;u7e Number
Date:
P
t d biL[:-6b2f? 2) auTpuavo uoa d0'. IO SO i
.: e