General Permits (4860)

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CERTIFICATION OF EXEMPTION 6)
FROM REQUIRING A CAMA PERMIT rJ C�w
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Com fission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
Address
Citv State
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.
Zip
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 (SCALE: )
r
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

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ADJACENT RIPARIAN PROPERTY OWNER STATEMEL , DEC7199t
T
I hereby certify that I own property adjacent to EVELYN
property located at 1104, NEUSE DR., LOT 8, USE HEIGHTS
(lot, block, road etc.)
on NEUSE RIVE _ in ORIENTAL ,
(body of water) (town)
North Carolina in Pamlico County. The proposal has been described to me as
shown below; a development, a pie �i�-r,e.�� revetment, and the proposed
(c1
location, and I have no objections to the proposal. I understand that if
the development is a pier, it must be set back a minimum distance of 15 feet
from my area of riparian access unless waived by me. ;circ�leone)
Swish to
waive that set back requirement.
Description and/or drawing of proposed development. (to be filled in by
individual proposing development) INDICATE THE SIZE AND LOCATION OF THE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND WATER.
FOR THE REPLACEMENT OF THE EXISTING BULKHEAD IN THE SAME LOCATION
120' +/-
(Original must be retained in the Inspection Department)
SIGNATURE
DATE 42 f� h
NAME, PLEASE PRINT

DEC 1991
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to EVELYiN AIKEN_---------------------
Property located at 1104, NEUSE DR., LOT 8, NEUSE HEIGHTS
(lot, block, road, etc,.)
on NEUSE RIVER in ORIENTAL ,
(body of water) (town)
North Carolina in Pamlico County. The proposal has been described to me as
shown below; a development, a pier _Z:'�Iftae)
Jrevetment, and the proposed
(ci
location, and I have no objections to the proposal. I understand that if
the development is a pier, it must be set back a minimum distance of 15 feet
from my area of riparian access unless waived by me. I� wish to
;circle
one)
waive that set back requirement.
Description and/or drawing of proposed development. (to be filled in by
individual proposing development) INDICATE THE SIZE AND LOCATION OF THE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND WATER.
FOR THE REPLACEMENT OF THE EXISTING BULKHEAD IN THE SAME LOCATION
120' +/-
(Original must be retained in the Inspection Department)
J, Lla-n�
SIGNATURE
DATE �� � � �-���
-r�R LF S '4� L---
NAME, PLEASE PRINT