General Permits (5058)

.09
CE-RTIFICA—TI.OrN OF EXEMPTION rc�f
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-NGAC,Subchapter.74<--eee3.
Applicant Name Q4 Y Phone Number 7- ?4,
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Address j6,-i �, „
City /voy ems, State A ►C, zip
Project Location (County, State Road, Water Body, etc.) 60
Type and Dimensions of Project
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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,too'45••NCAG-•7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
f . ..... l
I ile Wit_<�
This certification of exemption from requiring a CAMA permit is
valid for J,adays 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 (SCALE: ) I
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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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Applicant's signature
CAMA Official's sTgnature
9- f `%
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to %>Q dy 6 Sy b `�-11'-'S
(Name of Property Owner)
property located at /v �C 1c,�' 2— s �j ./z o p '1.5-1
(Lot, fRiock, Road, etc.)
on EU� �> 1 ,d:-Zf , in &U A)T N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, die development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/uncovered boat lift
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 dq wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Telephone Number
Date: JULr 10