General Permits (4581)

�0CERTIFICATION OF EXEMPTION G. � o/
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
Address
Phone Number
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
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.ccrtification 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 e't;, )' (SCALE: ) I
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
1�
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

J
CAMA
25 d.
March 23, 1999
Gus Johnson
1178 Merrimon Rd.
Beaufort, N.C. 28516
Dear Gus:
Attached is a Certificate of Exemption From Requiring a CAMA Permit to construct 200, of retaining
wall on your property located at 1178 Merrimon Rd., in the Township of Beaufort.
In order to validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy
and the attached regulation (7K .0203) 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,
Charles O. Pigott
Coastal Management Representative
COP/rcb
Enclosures
North Carolina Department of Environment and :Natural Resources James B. Hunt Jc, Governor • Wayne McDevitt, Secretary
Division of Coastal Management Donna D. Moffitt, Director
Morehead City Office . 151-B Hm-. 24 / Hestron Plaza 11 Morehead City, NC 28557 • Phone [phone]

JAN-21-1999 12:00 FROM DCM MOREHEAD 919 247 3330 TO 2232105 F.01
ADJACENT RIPARIAN PROPERTY OWNER STATEMFA7
/f
I hereby certify that I own property adjacent to
(Name of Property Owner)
prom rty located at u 7> ffl �rrl m r� i� I� P/���� h �L . C " .>
(Lot, Block, Road, etc.)
on G2e-- tz- /L , in �2L , 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.
DESCRIMON AND/OR DRAWING OF PROPOSED DE`FrELOPMLNT
(To be filled in by individual proposing development)
/)arn 15e-14
S%ar m r 14&6 0 S /NC1.7 u �g
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Signature
Print or Type Name
KZ5Z,) _5-/4i ---/7 /6
Telephone Number
Date:
TOTAL P.01

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