General Permits (3264)

Applicant
City /I
Project 1
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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT C ��� /IV
O QU G v...p ,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.
70 A ev- Wok e-n Ar,• -0to/ 5-0-1 Phone Number
ion (County, State Road, V�ater Body etc.)
Type nd Dimensions of Project !• i%, (� n
C� Cl
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 (SCALE: )
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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.
CAMA Official's signature v
I_ �.CZ�
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

03/11/1992 00: 00 919b3 i55 '? STiwr LY HALL
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PAGE 01
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LOT 64 Ips
35,825 SO FT
REFERENCE RESTRICTIVE COVENfNTS FOR R(STRICTIONS AND
EASEMENTS THAT MAY APPLY
0 8EARING AND OR 015TANCE CHANGED TO CORRECT ERROR
OF CLOSURE IN SMMSION PLAT
A POHTION OF ME PROPERTY AS SnOWN DOES FALL "THIN THE FFCERAL.
FLOOD INSURANCE RATE MAP ONE HUNDRED (100) YEAR FLOW PAIN.
CgRTIFICATE OF SURYEY_ANQ ACC R1� ACY
I, JERRY R. RYAN, CERTIFY THAT THIS PLAT WAS DRAWN UNDER
L'Y SUPERVISION FROM AN ACTUAL SVRYFY MADE UNDER MY
SUPERVISION, THAT THE RATO OF PRECISION 15 I' 15,DD0+ THA'
TNIS PLAT MECFS THE MINIIJUM 57ANCARDS FOR LAND SVAVEYING
IN NORTH CAROLJNA A; AMF.N0F1' A. '�lr OOVNOAQ'CS NO'
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ADJACENT ��
v ARIAN PROPER I'Y OWNW STATEMENT
(FOR A PIERAVOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 7,,E�_,s
(Na;ae of Property Owner)
property located at \, ©T (,o`-\ SEA_-T� ,��_ <,���� •�a,��� 3�0.� p.�v�R
(I.ot, Block, Road, etc.) '
on inN�c� F�E�N C'P�c�yE��
(Waterbody) N•C.
(Town and/or County)
He ;:,.s descrir ed +n mP ac +,— 1 .
;,e i prOPosing at that
location, and, I have no objections to his vproposal. I understand that a pier/mooring
pilings/boatli:t/boathouse must be set back a minimum distance of f1hern feet (15') from my area
of riparian access unless waived by me.
_..A"� . I don wish to waive the setback regi�irement.
I �2 wish to waive that setback requirement.
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D F.S CRIPTIO------'-----------
N AND/OR DRANVJNG OF P"OPOSED D'1VELOPWEINT:
(To be filled in by individual proposing development)
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Print or Type Name
Telephone Numb
Date: ` l l

ADIA
JACENT RIPARN PROPERTY OWNER
NT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOU� SE �
I hereby certify that I own ro 7
property adjacent to , P, W �.yF ��-s,P.EV�E� 's
(Name of Property Owner)
property located it� � �y � SEc-T� �-�.
(Lot, Block, Road, etc.)
on
(Waterbody) (Town and/or County) N.C.
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/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fir"teen feet (15') from my area
of riparian access unless waived by me.
I do -Dot wish to waive the setback requirement.
I Lo wish to waive that setback requirement.
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DESCR-PTION AND/OR DRAjVING OF IPOPOSED DEVELOPMENT:
(To be filled in by fndfvuual nM,)o P development)
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Print r Type Name
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Telephone lumber
Date: O