General Permits (4004)

• J CERTIFICATION OF EXEMPTION
-1r-
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 Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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 authorizatio%:
I SKETCH (SCALE: ) I
P
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.
E
F.
4-f
i
Applicant's signature
i
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER-FORM
Name Gf Individual Applying For Permit: _Ch,;e
Address of Property: SI A Ne-se Or. Nei.,- Bel"A,/c_, p85'6o
(Lot or Street r, Street or Road, City & County)
I hereby certify -that I own property adjacent to the above -
referenced property. The individual applying for this permit has
described to me as shown on the attached drawing the development
they are proposing. P_ description or drawing, with dimensions,
should be provided with this letter.
I have no objections to this proposal.
If you have oblection_ to what is being or000s_ed ple__se write the
Division of Coastal Management. .127 Cardinal Drive Extension,
Wilmington, North Carolina, 28405 or call 910-393-3900 within 10
days cf receipt of this notice. No response is considered the same
as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbags must be set back a minimum distance of 15,
from my area of riparian access unless waived by me. (If you wish
to waive the setback, you must initial the appropriate blank
below.)
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
S ignA— - e
Print name
( //// (a/�-r/4 f
Telephcne Numher With Area Code
ate
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WL
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-- RESURVEY FOR --
LOU IS M. CURTIS III
CATHY H. CURT I S
812 NEUSE DRIVE
ALL OF LOT 043 — NEUSE VIEW SUBDIVISION
NUMBER 7 TWP. — CRAVEN CO. — NORTH CAROLINA
DECEMBER 19, 1995 SCALE 1"= 40'
GRAPHIC SALE
O 10 20 30 40 80
DEED REFERENCE DEED BOOK 989 PG. 026.
MAP REF. MAP BOOK I PG. 44, AND AB. 1 PG. 177.
TAX PARCEL ID N 7-006-247 CRAVEN CO.
IPF - IRON PIN FOUND
CL - CENTERLINE
INT - INTERSECTION
TOTAL ACRES • 0.93
m
FRAW SHED —
ENCROACHES 0.4'
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER-FORM
Name Of Individual Applying For Permit: C A,,p 4- KOLAy C.,-f,'J
Address Of Property: 910. /✓ease oe . /New 8«n X �✓,c , ,zes-X,
(Lot or Street J, Street or Road, City & County)
I hereby certify that I own property adjacent to.the above -
referenced property. The individual applying for this permit has
described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is beina ur000sed,-ole=.se write the
Division of Coastal Manaaement..127 Cardinal Drive Extension
Wilmington, Norl--h Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No resugnse is considered the same
as no objection if you have been notified by Certified Mail
r
FFAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbags must be set back a minimum distance of 15'
from ry area of riparian access unless waived by me. (If you wish
to waive the setback, you must-- initial the appropriate blank
below.)
I do wish to waive the 151setback recuirEment.
/ I do not wish to waive the 15'setback requirement.
Print Name
ci — /_ 2.2 _ Q 0/7l
Telep`hcne Numbe:, with Area Code

-- RESURVEY FOR --
LOUIS M. CURTIS III
CA THY H. CUR T I S
812 NEUSE DRIVE
ALL OF LOT 1:43 — NEUSE VIEW SUBDIVISION
NUMBER 7 TWP. — CRAVEN CO. — NORTH CAROLINA
DECEMBER 19, 1995 SCALE 1'- 40'
CRAPHIC SCALE
O 10 20 30 40
DEED REFERENCE DEED BOOK 989 PG. 026.
MAP REF. 94P BOOK 1 PG. 44, AND AB. I PG. 177.
TAX PARCEL 1D 4 7-006-247 CRAVEN CO.
IPF - IRON PIN FOUND
CL - CENTERLINE
INT - INTERSECTION
TOTAL ACRES • 0.93
FRAW SHED --a
ENCROACHED 0.4' j
/� NEUSE
fie
usE a1,sR
NE --N sITE
0.p F TO
To HAvtloo
— VICINITY If4P —
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