General Permits (4548)

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Applicant Name
Address ��
F EXEMPTION
CERTIFICATIONO �
FROM REQUIRING A CAMA PERMIT �'� 51e k,
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.
�'f Phone Number ��
City !2tf-4 r /C *1 /'
Project�ocation (County, State Road, Water Body, etc.) i c
State
zip +/
Type and Dimensions of Project i%1,4
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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 ;;I ir; �" 1 ^ (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.
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CAMA Official's signature
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Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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
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EDEHNR
DATE: !q- 7 , 1997
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,
sl
Field Representative
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Enclosures
AM
Hestron Plaza II, 151 B, Highway 24, Morehead City NC 28557 N%,14
Voice 919-808-2808 FAX [phone] Courier 11-12- w l C An Equal opportunity /Affirmative Action Employer
50% recycled / 10% post -consumer paper

APR-02-1997 10:41 FROM FURST INS. & REALTY TO 19192473330 P.02
ADjACEN T RIPARIAN pRoPMTY OWNM, STATEWI NT
fFOR A PIEWHOO ZING PILINGSIBO"LlFI'IBOATHOUSE)
J 'S
I hereby certify that T own property adjacent to N _ �%1 +
(Name of PropertyOwner)
property located at �t1p /` c� + 6E'.r,/S h0-AW
(Loot, Bieck, Road, etc.)
an ,fi r in ,) , N-C.
(Waterbody) . (T'awn d/or Cauuty)
He has described to me, as shown below, the development be is proposing at that
location, and, I have no objections to his proposal, I understand that a pier/mooring
pilings1boatlift1bb thouse 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 Kish to waive that setback requirement.
DESCREMON AND/OR DRAWWG OF PROPOSED DENTLOP:1iENT:
(To be filled in by individual proposing development)
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Signa
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Print or Type Name
?/0-7S',?- .S-/�'r
Telephone Number
Date: r 7
TOTAL P.02