General Permits (5503)

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 ,�` tx �ii'�T Phone Number
Address
City ' % ! State ,(X Zip
Project Location (County, State Road, Water Body, etc.) 77, s-!` !
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 NGAC 7K-.0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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
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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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

e
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A11-fA-) �-A<)6(C
POPS-7- is property located at Lojs '200 ?Q�3d, N{UfrL•J/it) k5 ' rpz54(✓/1DAu
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lot, block, road, etc.
on ()J?4f P)" eREEK in 10694LICCOk)7-r- f N.C.
(body of water) (town and/or county)
The proposal has been described to me as shown below: the development, a
pier/ 6lkhead structure, and the proposed location, and I have no objections
(circ-re one)
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 do/ do not wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed.development: ( to be filled in by
individual proposing development.)
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ORC
HARO CREEK
(Original must be retained in tInspetijon Department) /7
S i8n die� /
C�� � d�f ups G'A�r �3✓�?,�T%'
Name (Please Pri t)
biv�s of !offs1?6� Nc�s

CERTIFIED *AkM
RETURN RECENT R 1~' • TED
Dear REb L)- RFI-L
Tlis letter is to Notify you as
as an adjacent riparian landowner of Mf�r/ r,,r7
Al IQ-f•�N6tr PA1Et7" —plans tQ 4Vn5ltUCi��.PRtx1 i%i-ry' �3�� � f%i= �f 1 !/'
-O -r% U7 FR�Ui�D St�10�'C
on their property located at CIL
in PpmoGC'ycw7"f ' , NC. The sketch can the revCrs; side accurately depicts the
proposed construction.
Should you: have no obje--iions to this propcsiii, please creek the statement below, Sian
a -rid date the blanks below the statement, and return this letter to: A 1�,AJ AN,O J?,c16I,.
as somas passible.
Should you have objections to this proposal, please send your an-itien comments to the
N. C. Division of Coastal iilana ern -tent, Hestron Plaza 11, 151-B Hwy 24, Morehead City, NC
28557. Written conunerts must be received within (10, days of receint oftlus notice.
Failure to respond in either method N)itnin iI01 days will be interpreted as no objection.
Sincerely, &t_u
AWZ --
I have no obiection to the protect as presently proposed and hereby waive that
riant of objection as providers in General Statute 113-229.
Y have objections to the project -as presently proposed and have enclosed
comments.
Signature
DATE.

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5 28'�58 06" E
j HOWARD H1NK ET AL �17
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