General Permits (6382)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT r,
as authorized by the State of North Carolina, V
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
Address =i
City r .
Proj ct Location (County, State Road, Water Body, etc.)
Phone Number (J 11 d % 9 y
_0
State Zip
k h �i'-_ i f 7.; aP
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.
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

JUN-17-98 WED 03:29 PM CEDAR PT TOWN HALL 91939Z3205 P.02
ADJACTM RWARLAN PROPERTY OWNEKSTAB N'T �' S
�? (FOR A PIERIMOORING PmjivGSIao 1TZI.p7'li7 ATHI usq
I hereby certify that I own pmgcrty adjacent to =s
(Name of Property weer)
property located at
r�A'
.�an r? N..
(Waterbody) (Tor nty)
he has described to me, as shown below, the development he is propo=g at that
location, and, I have: no objections to his proposal. I understand that a pier/mooring
piiings/boat3iMoathouse -must be set rack a minimum distance of fift= feet (15') from my area
of riparian access unh= waived by me.
V -- I do not wish to waive the setback zequimneut.
z .0-0 wish to waive that setback requirement.
DESCR MON AND/OR DRAWING OF pRopOSED DEVELOPMENT: �Y _
(To be ftMed in by i vidual proposing dewia Arent}
A Cx
XJ /S'y Ib .ry �i� %ass �o ` "
y IXX6X6 VCam. -- Sa
Punt or 'Type Name
91�
Telephone Number
.Date. C�

JUN-17-93 WED 03:30 PM CEDAR PT TOWN HALL 9.193933205 P.03
s _
ADJ',AC'O?r x"ARIAN PROPMTY OWNER STATE , Q
- (FOR A PIERIMOORING P&MGS1B' 0g7UFT12jgATH0USE)
I hereby certify that I own property adjac4=t to
< s
Property O x)
7,
� C.
(W aterbody) UFOWn andfo County)
7
He has described to me, as shown below, the devclopawnt he is proposing at that
location, and, f have no objections to his Proposal-- I understand that a pier/mooring
Piiingslboatliftiboathouse must be set back a minimum distance of fifteen feet (15') from my area
Of riparian access unless waived by me.
I d na wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPh 'I;
(T'o be Xed in by tndivid� pmposintg development)
� '/to pX /6 a s/XR 0 /X Yz?
-!S7-E jCj_ jj CHEp
Prim nT Type Name
T eph a Number
Date: Y l f - �,f

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