General Permits (5645)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, Ir
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
jin an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant fame f /', j
Address
City
Project Location (County, State Road, Water Body, etc.)
Phone Number
State L '
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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.
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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 ,:� �? / r, (SCALE: )1
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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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Appicant'ssignature
CAMA Official's signature .>
Issuing date
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Expiration da e
Attachment: 15 North Carolina Administrative Code 7K .0203

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June 9, 1997
Mr. Charles Pigott
Field Representative
State of NC
Dept of Environment
Health & Natural Resources
Division of Coastal Management
Hestron Plaza II
151 B Highway 24
Morehead City, NC 28557
Dear Mr. Pigott:
Asper our telephone conversation today, 1 have enclosed the
signed copies of my permit. As we discussed I have also enclosed
a copy of the original approved diagram which details how the
dock will be built. Ifyou have any questions regarding this
matter please call me at you convenience.
Your assistance in this matter has been greatly appreciated.
Sincerely,
Ir
Tom Rojy

,A -
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify, that I own property adjacent to
s property located at
(Name of Property Owner)
o .T 1.2 f /GPI.' 7 Z:/ /' /,? ') ,
�1 (Lot, Block, Road, etch.)
on 1=�;%r,�� S `�i / 1 �� i n Lf,/ll��/� �����i N. C.
(Waterbody) (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.
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DESCRIPTION AND/'OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Print or Ty e Name
Telephone Number

ADJACENT RIPARIAN.PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Mr. and Mrs. Thomas J. Rojy Jr. 's property located at
(Name of Property Owner)
Lot 12 Hurst Harbor North
(Lot, Block, Road, etc.)
on,Foster's Bay , in Swansboro , N.C.
(Waterbody) (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.
DESCRIPTION AND/'OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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My "NO OBJECTION" is based on Signature
all constr ti including
any i I, ie ups for Edward E. Penuel
boat bgirig located not less
than ' from my riparian Print or Type Name
property lines.
[phone]
Telephone Number

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