General Permits (4191)

O
Applicant Name
Addres
City
CERTIFICATION OF EXEMPTION `v ro,,1
FROM REQUIRING A CAMA PERMIT ri i- I S�
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.
and Dimensions of Project
J ­-, -, -*-
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.
Phone Number
Zip _2_SL5^
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 t �J (SCALE: )
s1
s
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 si nature A r
CAMA Official's signature V
Issuing date
_) - 3J — ,7 2
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

5,40 2,57s, /c
ADJACENT RIPARIAN PROPE'hTY OWNER STATEMENT
I hereby certify that I own property adjacent to
44r:'. (�DAu t-r i L KS'C�L ' s property
located at _ (�� k-LLCA r� r c; 67 on
WoF'F /A,(LLT _ (Lot, Block, Road, etc. )
Gam- �G t' S'C> 10 in PiAiC Kn/o" S'�+o2t-S' N.C.
(Water Body) (Town and/or County)
He has described to me as indicated below the development
he is proposina at that location
and I have no objections
to his proposal. I understand
that a pier, pilings and
dredging must be set back a minumum
distance of fifteen feet
(15') from my area of riparian
access unless waived by me.
4
I do not wish to waive
that 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.)
:cl
o p 12— Ll N �4C
i-6&T O F 01 M q L
' 10 12cPL4 C' 6'
Pi -4 CL EO `T)/d_Ec Ti LI.J
i t F !�0 �T O OC I� S 6A1c)A C(_�
Z
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luLEr- C'NAt NOC --
Signature :*
_ `- / 7 r-,
Print Name
1A L I j_1
"red
Date
_ 7e-,3 -- '7S - ZOOS"
Phone Number

Y
S!-W 2CS� /IC
ADJACENT RIPARIAN PROPLtZ'I'Y OWNER STATEMENT
I Hereby certify that I own property adjacent to
�4%. Is property
located at _ 6)A�LCA % �� i Llc on
I�vr.F1;i /k(LLnr _ (Lot, Block, Poad, etc.)
UGTUc S'ou"0 in Jni/�� KNO[� �'¢F�2c-S' , N.C.
r(Water Body) ('Town and/or County)
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
XI do wish to waive that setback requirement.
Description and/or drawing of proposed development:
(To be filled in by individual proposing development.)
I'Ns�q��gTio�l of
I o (2cl't�(e �' '�E i CFZ � �.4q•jE�
,A/jo
Date
i-EcT o f U l k i-q L
r i t h!'0'4T 017 04:9 S'cAO-I LC.�
L1, .4 y L S' EAr C)A L.Lc-' �7-
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�z
" /�z li z
Signature
Print Name
Phone Number
IP

O
Applicant Narne
Address
City `, !rIfs
Project Locatiion
F EXEMPTION 9
CERTIFICATION O EXEM TON �
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.
Phone Number�t =>
I r 1C t -Y" (f (' h.
oupty, State Road, Water Body, etc.)
Type and Dimensions of Project " f r,. ! tt'��!
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.
M.
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 _ ')i~'. ? J-_. i JJ6 (' rj�(J (SCALE: )
" Lc � �: ck"
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.
Cc�C�I,I(C� All c
JAN 1 4 1997
Applicant's oignature
CAMA Official's signature
i i I
Issuing dat6
fl/ 3 l
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

F
1164 Ott,
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Wrightsville Beach. N, C. 284W
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MAP BOOK 9 PAGE 27
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R/W
U. S. HWY. 74 k
SURVEY FOR
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MARION JEFFERY & DIANE ' M. DUBOSE
,�N .netrt
•.•••r�t�• C•RC��'•. LOT B DIV. OF ATKINSON DREDGING CO. LOT
9 WRIGHTSVILLE BEACH j�j SpECIAL, NEW HANOVER COUNTY, NORTH CAROLINA •
MARCH 4, 1992
E 75 S MAP BOOK 17 PAGE 29 FLOOD HAZARD AREA
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GRAPHIC SCALE
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ST�i�2'..l•••ftNSON do ASSOCIATES c n+ ryzr I
ONE NORTH 6th ST.. WILMINGTON. NC 1 1ae° - 40 R