General Permits (2264)

•�' CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, (0/ / l
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_ K.X 40, /7 -) Phone Number
Address i 5 - 7—
City F le-, ti State v d Zip I1 it'll
Project Location (County, State Road, Water Body, etc.) r/ , t �� l �'v 1 k 6_F an 4 < /, , :,, s
1 0 / n. / (1-) .r _. [. ii 1 L f ',I- C P%n
Type and Dimensions of Project i J f S n' L)e v .o c , ) / " 1 a r f t
0 { g
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 (SCALE: )
r
t
;Y
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.
t/
INK
1 1 c
Applicant's signature
;
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

DEC-29--1994 13=53 FROM BRYANT REAL ESTATE TO
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12/28%94 09:16 FAX [phone] CAROLINA LAND
* "ff-%CE "r IMP
I hintebY mortify that I ®vn
Name
i'ty ad ] hCcnt two
—.a provertY
1©ca�td a _
(Lot,
IsBinc .Fifl$ �i��c,- 1.
lts f'J� i r� l at={� 4e ac- i Car g . - -
Wai6S B0dY) crriwn andfor ucs—&-yi
7E� has tea me an sti wn 11,4 10V the develvpinEant hc3 is
preptrsir�g at that locution a d I have nb O je�t_ionr- to hi-
prop�gal- t nderstand that a pier mut b e s�tBYea�
uof
toitti>sua+ distaxgcc,ca�.;�iYte�n eet (2S s) from my
r3Pa=yan aCC�sS Llnler3s V2LkVe 'bY
i ciao Host wish t® via 3 v� Gtia� �4f•tb�C}i' ��tzisemerst _
;Z d+a 9+] :t► to vex a Gloat$tt3acic CS$V 11 �'im4 i74=-
ucacYiPc l4n gnd�oC drZv liLCj Or propus@d. A velcvm@nt- (To Sr-
FILI.EII IN BY INDYVXDUAU PROPOSING OiKVEX-UP E:NT2
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12/28/94 09:12 FAX [phone] CAROLINA LAND IA004
ADJACENT RIPAR AN PROPERTY UWMrm a,.AIlK-Pa
I hereby certify that I own property adjacent to
Co 10 S s, property
ji]Namee
located at 4-1 -itI t 364-Aulm3c,W010�-- , LOn
(Lot, Bloc ,Road, etc.) /� -}-
T ((_1 � Ln �. aftet ' 1
p L),Wl cree � i,n ,N-C
-
(Water Body) (Town and/c5f County)
He has described to me as sh wn below the development he is
proposing at that location a d I have no ahjections to his
proposal. I understand that a pier must be set back a
minimum distance of fifteen leiet (151) from my area of
riparian access unless vaive by me -
I do not Trish to waive that setback requirement.
I do wish to Arai a that setback requirement.
Description and/or drawing of proposed development- (TO BE
FILLED IN BY INDIVIDUAL PROP SING DEVELOPMENT)
i
Signature r
Name
Phone Number

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