General Permits (2303)

-ter- CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMITF Ias authorized by the State of North Carolina, i`"°"" inns
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 %t C• 9 ::? 7 3
Address /e,'S'
City 114- T State A/ c zip
Project Location (County, State Road, Water Body, etc.) Via, ram/ o it S • t n
J
Type and Dimensions of Project V ' 4-: << tlr <e</ 4C /
rr>,� /ellL-e,-74 e-,- /ef A' c -
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 cert&atiofl-of exemption from requiring a CAMA permit is
Ireslid for 90 days from the date of issuance. Following expiration,
-examinaVon of the project and project site may be necessary
to continue this certification.
/)E" c - CcJ P%/;
SKETCH (SCALE: �, )
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
2-14
CAMA Off icial's,.9lignature
Issuing d to
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

Authorized Diesel Itjectiun. Electrical. & Turbo Specialists
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Diesel Equipment Company
P.O. Box 16066 212-220 AtweY Ave.
GREENSBORO, N.C. 27406
A.C. "AL" DEANS Phone
President [phone]
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FUG 31 '95 14:17 DIESEL-ECAJIPMENT CO. 91937043600
P.2/3
r
kAJACENT RIPARIAN PROPERTY OWNER STATEMENT
( FOR A PIER)
hereby certify that I own property adjacent to
located at
, Block, Road, etc.
's property
on
in O'de4, 0 / *, N.C.
(Water Body) (Town and/or counter)
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 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 that setback requirement.
;f �I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FIIJ IN BY IIMDIWDUAL PPDPOSING )
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Name
Phone Number

F1UG 31 '95 14:17 DIESEL -EQUIPMENT CO. 91937043500
P.3/3
■
ADJAC WT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
's property
L�G{luc
located at . lQ . v,vE• • _ , on
(Lot, Black, toad, etc . ?
itl��....7�.�Y��' _, N.C.
(Water Body) ( 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 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 that setback requirement.
✓ I do wish to waive that setback requirement.
Description and/or drawing of proposed -development: (TO BE
F1L IN BY INDIV DUAL PRdPOSING DEVEMPI02T)
Signature
JAI, ceOV
Name
q)��_�G�7it
Phone Number