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HomeMy WebLinkAboutGeneral Permits (4045)Ir i CERTIFICATION OF EXEMPTION u 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 lrltfI✓Z Phone Number ;';_ OV73 Address ki, 61 6 City 7:,X. State zip ? ` Project Location (County, State -Road, Water Body, etc.) Type and Dimensions of Project C— 1�4 q A S 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. I SKETCH (SCALE: ' .,; ) I .L C't P F, �- 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 CAMA Official's signature Issuing date Expiration date Attachment: 15 North Carolina Administrative Code 7K .0203 r POBOX 776 PAMLICO COUNTY BUILDING INSPECTIONS BAYBORO. N.C. 2B515 (919) 745-3861 (After this form is completed by the landowner proposing the project, a copy is given to his/her adjacent landowners for their consent and signatures. The forms are then returned, along with a building plan and other applicable required information, to the Building inspections' office for building permit application/processing.) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT EPN# t hereby certify that I own property adjacent. to CW14C- CN"—LAN ,s on Ai:%c,,C;;j C L t—: F IC Name of landowner proposing development body of water in/near-)AwSc>-J CPEt►c H ILL-5 Lot# 16 of 5L-?j C'2c E-k Hs community Subdivision, if applicable Tax Parcel # ,q )}% off SR J v Complete description of how to locate this property: Lcfi Orr= S� iae�• �.� `r�f}u3,c�� CrEEic' G>p V The proposed project, a �7 and the location has been described to me as shown in the drawing below and I have no objections to the proposal. FOR A PIER, CHECK ONE OF THE FOLLOWING: 1 wish to waive the 15' minimum setback from my riparian access. X 1 DO NOT wish to waive the 15, minimum setback requirement. Draw the proposed structure in the space provided below. List the size of the structure and measured distances from the adjacent property lines, other structures on the property, and the road, water, etc. P l Y0 C - -vl r L Y , Printed Name 6i9204-i) �, /�,g� t�wi,� Date_jyLZ�7 Signature I PUBOX 776 PAMLICU COUNTY BUILDING INSPECTIONS BAYBORU, N.G. 2BSl.`) (919) 745-3361 (After this form is completed by the landowner proposing the project, a copy is given to his/her adjacent landowners for their consent and signatures. The forms are then returned, along with a building plan and other applicable required information, to the Building inspections' Office for building permit application/processing.) ADJACENT RIPARIAN PROPER'rY OWNER STATEMENT EPN# t hereby certify that I own property adjacent to car Pr C +4 py2 tk-N'3_,_) —Is on Name of landowner proposing development body of water in/near _NSpa+ C2tEtc H t LL-5 Lotii 26 Of DA"05L Hi <<-5 community Subdivision, if applicable Tax Parcel �� 1 �f $ off SR Jv Complete description of how to locate this property: ccti 5P, !34- �.� +�A �c,� C�tE1c '�),Pjv The proposed project, a and the location has been described to me as shown in the drawing below and I have no objections to the proposal. FOR A PIER, CHECK ONE OF THE FOLLOWING: 1 wish to waive the 15' minimum setback from my riparian access. I DO NOT wish to waive the 15, minimum setback requirement. Draw the proposed structure in the space provided below. List the size of the structure and measured distances from the adjacent property lines, other structures on the property, and the road, water, etc. c fP I st~ °�a'� 5 ��' U) c � � Q :�I, a-,-, Printed Nan)'�MC,5 (i. (t?YA&J A tit ct! Date ' a —% Signature i" ��,o f 6G)" l V