General Permits (2458)

r CERTIFICATION OF EXEMPTION
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 c c, / , Cl-.�r� i' Phone Number
Address _ ���� G
City l State rNG Zip rd.S
Project Location (County, State Road, Water Body, etc.) �o -
Type and Dimensions of Project Yi?
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.
.Q20&
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.
is a subsequent aetermination mat a perms was requirea for ine
development. CAMA Official's signature
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /Lloyd Minshew , s
property located at Lot 31 Tradewinds MHP on
--(lo , oc roa , etc.) (water
Bogue Sound in Indian Beach N.C. He has
o y own and/or county)
described to me as shown below the development he is proposing at that
location and I have no objections to his proposal. 1 understand that a pier
must be set back a minimum distance of 15 feet from my area of riparian
access unless waived by me. I do/ o no` wish to waive that setback requirement.
(circ ne)
Description and/or drawing of proposed development:. (to be filled in by
individual proposing development)
signature
Alicia Dalrymple
n
qr CTa S-V
phone number