General Permits (5957)

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CeTGN70F EXEMPTION
—Y
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 r, t � Jr�P y� Phone Number 60—?— 73S S`o37
Address -P
City a, :n State Zip D323.f
Project Location County �S�t%to Road, WaterrBody,
etc.)
I3 /�!.!l�a�
►ype and Dimensions ot.Nroject
S-Q-P 60 /O�v
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 98-days from the date of issuance. Following expiration,
quirement pursuani to-1-b--.p1.6AW.Y-7iE�-This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE: /j/,,,• _ ) 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.
Ap icant's si re
CAMA Official's sig ture
Issuing date
7. 3i , q7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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hereby certifythat I own property adjacent to (L
P P Y J
' s property located at /,
ot, b eck, roa , etc.)
on i n ` c G�CD N. C.
(water body) (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 this ier, ulkhea), groin structure
(ci one)
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
(circle one)
waive that setback requirement.
Description and/or drawing of proposed development: (to be
filled in by individual proposing development)
(Signature
(Name)
6� (zw C� YjZ
(Phone Number)

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I hereby certify that I own property adjacent to
' s property located at
( t, block, road, etc.)
on in U Q-'-v' l ac r-D C 6- , 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 3 ons to his
proposal. I understand that this pier, bulkhead, qroin structure
( rcle on )
must be set back a minimum distance of 15 rom my area of
riparian access unless waived by me. I do, do not wish to
cle one)
waive that setback requirement.
Description and/or drawing of proposed development: (to be
filled in by individual proposing development)
is IL&
Signature)
LR-
1 M4 �L-L S,:ram►
(Phone Number)