General Permits (5106)

CERTIFICATION OF EXEMPTION
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 Phone Number
Address
City State Zip -f 7
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.
ISKETCH
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.
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.
F' A), P 1
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.
(SCALE:
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY OWNER STATEMDqT
(FOR A PIERIMOORING PILINGSIBOMLIFTIBOATHOUSE)
5 z Z'
I hereby certify that I own property ro adjacent to C'; 's
(Name of Property Owner)
property located at
�42i'5'n
(Lot, 131ock, Road, etc.)
on �� C�i� S t%a Cin i�� 1 P2 �� �����v , N.C.
aterbody) (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. I understand that a pier/mooring,, k ('- S f
pilings/boatlift/boathouse 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 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
SEE ATTACHED PLOT PLAN
Signature
Print or Type Name
Ll
Telephone Number
Date:

Y
ADJACENT R.IPARIAN PROPERTY OWNER STAMMMu
(FOR A PIER/ GORING PILINGSIBOATLITTIBOATHOUSE)
I herebycertify that I own roe adjacent to CC�4 ` �4/j 's
fY property rtl' 3 1' `�
(Name of Property Owner)
property located at
(Lot, B1oEk, Road, etc.)
on l2 7r12C-� 0,0w/1�4, N.C.
aterbody) (Town and/or County)
He has described to me, as shown below, the developmert he is proposing at that location, 'and, I have no objections to his proposal. I understand that a pier/mooring AXc5C
pilings/boadiftlboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
r dodo not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
SEE ATTACHED PLOT PLAN
I Z .4�
ScK jZ^ f 007,4
-o07
Signe
rint or Type Name
i�
Telephone Number
Date:
1

EIP-EXISTING IRON PIPEy NC 24
SIP -SET IRON PIPE
EIR-EXISTING IRON ROD AUDMDRA COURT
SIR -SET IRON ROD
r ECM -EXISTING CONCRETE MONUMENT
SCM-SET CONCRETE MONUMENT
cr z EPK-EXISTING PK NAIL Z ►°�
SPK-SET PK NAIL
EN -EXISTING NAIL, ,
SN-SET NAIL
O PROPERTY LINE - —
RIGHT OF WAY LINE -------
UTILITY LINE - - - — SPOONERS CREEK
FENCE LINE x x x
COMPUTED LINE —
LINE - -
DITCH LINE
- VICINITY MAP NTS
DITCH
AREA SUMMARIES FOR CAMA
I RESTRICTIONS
TOTAL AREA OF LOT ----- 21640
SOFT
TOTAL AREA OF LOT WI IN
1 I AEC --- M24 SOFT
I via l61 � � I AREA DWELLI83b SNG TI OVER
!�AEC---1OFT
I �I �-
I
I I V
S 87°47'00"E 214.71
SN
(]
� � S'MBL I 47.88' MO / u
C;I PROPOSED DrLLIMO
� W m
0 3 I VACANT LOT I m I -D-1
, I o m 3 ITI
O M I "' I o °i ;u
J n O 0
o — — — 15'MBL I _ z
� r"
N 87°46'53"W 218.25' SN
AEC AREA
I I
I
I NOTE: BULDINO DIMEN91ONS ARE
�_+ IAPPROXPAATE. DO NOT USE FOR
GROUND LAYOUT.
I
I 29 I SURVEY FOR
LARRY C. LEWIS
AND WIFE
REBECCA C. LEWIS
LOT 30 SPOONERS CREEK NORTH
MOREHEAD TOWNSHIP
CARTERET COUNTY NORTH CAROLINA
JANUARY 22, 1997 SCALE 1 "=50'
NOTES' AMENDED FEBRUARY 24, 1907 PROPOSED DWELLINO LOCATION
D8 688 PG 40
IMB 23 PG 5A
PIN#635616943267
FILE#97012LE
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REGISTERED LAND SURVEYOR 1, 'RI LLips I
'��/ I� T� ily \\`
L-3151 NORTH CAROLINA Q ' L-/AI I PILE \ \ \\
1210 ARENDELL ST. (THE LAW BUILDING))
PO BOX 3492 MORENEAD CITY, NC 28597
1319-240-4470