General Permits (4634)

CERTIFICATION OF EXEMPTION
'1r N L i c_o L _-",
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name
Address
City
Project Locator
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
C'fq�
ic
+v, Phone Number ' - rat 1
.` State zip
(County, State Road, Water Body, etc.) C?
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.
SKETCH
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 maybe necessary
to continue this certification. `
(SCALE:
l
�
\
T_
t I Cai>'F ` F 1 NE 1'
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
6
Attachment: 15 North Carolina Administrative Code 7K .0203

a
CAIVIA
June 7, 1999
Jerry Matthewson
c/o David Hodges
55 Bay River Shores Rd., South
Merritt, N.C. 28556
Dear Jerry:
Attached is a Certificate of Exemption From Requiring a CAMA Permit to construct a 6 X 50 ft
walkway on your property located in the community of Paradise Shores, in Whortonsville.
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,
Scott Jones
Coastal Management Representative
SJ/rcb
Enclosures
North Carolina Department of Environment and Natural Resources James B. Hunt Jr., Governor • Wayne McDevitt, Secretary
Division of Coastal Management Donna D. Moffitt, Director
Morehead City Office • 151-B Hvn. 21 / Hestron Plaza 11 Morehead City, NC 28557 • Phone [phone]

ADJACENT RIPARIAN PROPERTY OVWN R STATEMENT
' -hat -_ I o-w- n- =r(oPe -ma—dscet to - -hereb jn- --- -- —_s-property located---
at_-
— - ----- -- - ame -
- of Pr e.. Owner -
- - — -- - -- -------------
(Lot, Block, oad, etc.)
on C/�/jl�u df� Gy, in f vc3r✓ --N.C. -
(Waterbo y) - Town and/or County
- _ The applicant has described to me, .as shown below, _the development proposed at the above
_ location. I understand that any construction, excluding bulkheads, must be set back a minimum
distance of fifteen feet (15') from my area of riparian access unless waived by me.
I have no objection to the project as proposed but do not wish to waive the (15') setback -
requirement.
I have no objection to the project as proposed and do wish to waive the (15') setback
requirement. -
- I object to the project as proposed. - - - - -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT -
(To be filled in by individual proposing development)
_ Lx����
Its �
D h -`
Print or Type Name
Telephone Number
S' � altu
'V�
Date

— - -ADJACENT RIPARIAN PROPERTY OWNER STATEMENT_ ---
--- ---- -: _ _ I hereby ce that —Town. propea4jacait_to ---- - - - —
's_property_located at___---_.
- — - -- - -- - - -------- --- -- - -- -
- _ (Naame o ropeify- Owner)-------- - - - --- - ----- -
=--
- - (Lot, Block, Road, etc.) _
- - on N 4 i4 n� k� �i in P Ti -ca p _— -- - - -- _
_ N.C.
- (Waterbody) Town and/or County
The applicant has described to me, as shown below, -the development proposed at the above
location. I understand that any construction, excluding bulkheads, must be set back a minimum
distance of fifteen feet (15') from my area of riparian access unless waived by me.
- I have no objection to the project as proposed but do not wish to waive the (15') setback -
requirement.
I have no objection to the project as proposed and do wish to waive the (15') setback
requirement.
I object to the project as proposed.. -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
- (To be filled in by individual proposing development)
Print or Type Name
Telephone Number Date