General Permits (3276)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, O/
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 V e" �.
Address f (-. i/ Ar I?.
City 6.7-p., 1,4 f 1
Project Location (County, State
4 ,
Phone Number r% 17 _ 7 �( _/'
State Zip
Water Body, etc.) , o .-
v T-
Ty e and Dimensions of Project bi, f k' A -,P `1 d 7 v l ram- t
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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 �L'ttr (SCALE: )
C.S.. i� t � �' � ✓-� (�
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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.
r,rr 4`Y 9 /�J1 r't
CAMA Official's signature./ Lilnl. •.. 1-1 i
d1 l4- -�(
Issuing date
3 r
Expiration date ,•N��R�w���M
Attachment: 15 North Carolina Administrative Code 7K .0203
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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Coastal Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
OM
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Dear
IDEHNR
DATE: )) - " z l , 1996
Attached is a Certificate of Exemption From Requiring a CAMA Permit. In order to
validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy for
your files and return the blue and green signed copies to us in the enclosed, self-addressed
envelope.
Your early attention to this matter would be appreciated.
Sincerely,
i
Field Representative
/dh
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City NC 28557 N%f
`��An E ual Voice 919-726-7021 FAX [phone] Courier 11-12-09 C q Opportunity / Affirmative Action Employer
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
.' (FOR A PIERIMOORING PILINGSIBOATLIF (BOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
m
in
(Waterbody) (Town and/or County)
I
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 fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Name
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
r
(FOR A PIERIMOORING. PILINGS/BOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to
property located at
(Lot, Block, Road, etc.)
(Name of Property Owner)
I
on , in , N.C.
(Waterbody) (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/mooring
pilings/boatlift/boathouse 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 the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPNM T:
(To be filled in by individual proposing development)
Signature
Print or Type Name
Telephone Number
Date:

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Dear
This letter is to notify you as an adjacent riparian landowner of Mr/Mrs
plans to construct
on their property located at
in , NC. The sketch on the reverse side accurately depicts the
proposed construction.
Should you have no objections to this proposal, please check the statement below, sign
and date the blanks below the statement, and return this letter to:
as soon :as possible.
Should _you have objections to this proposal, please send your written comments to the
N.C. Division of Coastal Management, P. O. Box 769, Morehead City, NC, 28557. Written
comments must be received within ten (10) days of receipt of this notice.
. Failure to respond in either method within ten (10) days will be interpreted as no
objection.
Sincerely,
I have no objection to the project as presently proposed and hereby waive that
right of objection as provided in General Statute 113-229.
I have objections to the project as presently proposed and have enclosed
comments.
Signature
DATE:

CERTIFTED MAIL
RETURN RECEIPT REQUESTED
Dear
This letter is to notify you as an adjacent riparian landowner of Mr/Mrs
plans to construct
on their property located at
in , NC. The sketch on the reverse side accurately depicts the
proposed construction.
Should you have no objections to this proposal, please check the statement below, sign
and date the blanks below the statement, and return this letter to:
as soon as possible.
Should you have objections to this proposal, please send your written comments to the
N.C. Division of Coastal Management, P. O. Box 769, Morehead City, NC, 28557. Written
comments must be received within ten (10) days of receipt of this notice.
. Failure to respond in either method within ten (10) days will be interpreted as no
objection.
Sincerely,
I have no objection to the project as presently proposed and hereby waive that
right of objection as provided in General Statute 113-229.
I have objections to the project as presently proposed and have enclosed
comments.
Signature
DATE: