General Permits (6332)

CERTIFICATION OF EXEMPTION %
0
_Y FROM REQUIRING A CAMA PERMIT Ar.-� �� �� ,.��� r�, t" % ;; C
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` `1 `F+' t ' Phone Number
Address 7 f <
City State Zip h �i
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.
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.
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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

0
ADJACENT ]MIAMAN PROPERTY OWNER STATEAMN'1'
(FOR A PIER/MOORING PILINGSIIIOATLII I'IlIOATIIOUSE)
I hereby certify that I own properly adjacent to LO-6 e- - I e 41V/�E /1/Or2yr C 's
(Name of Property Owner)
v located at 5,-2 U 7 � C-�- ,
(Lot, Block, Road, e(c.)
n S o v )i e. r � � Ye e �� , in , � /� C /-16-A p ,,. 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. I understand that a pier/mooring
dings/boatlifUboathouse must be set back a minimum distance of fifteen feet (15') from my area
f riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�P � ��
l
V/
Print or Type Name
( 5�� -7a�-31 C,"/
JUN 0 2 1998 Telephone Number
Date: '5-ate-9F

4
U4/L�,/0 1
ADJACENT I11VARIA.N PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to W06f- z--t -cA,✓NE l 0/eyr E 's
(Name of Property Owner)
operty located at 52 U % Gr"6 C-�"
(Lot, Block, Road, e(c.) L
S�ooYi e r� l'e e ��' , in D N.C.
(Waterbody) (Town and/or County)
L lie
has described to me, as shown below, the development he is proposing at that
tion, and, I have no objections to his proposal. I understand that a pier/mooring
clings/boatlifUboathouse must be set back a minimum distance of fifteen feet (15') from my area
f 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/Olt DIL411VING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
��l JA'a", P11-11
JUN 0 2 1998
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gignature
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Print or Type Name
Telephone Number
Date: 5 - d2 - Y