HomeMy WebLinkAboutGeneral Permits (6392)x����`�U�U^���Ux��K x�� �`��������U���U L/
CERTIFICATION ��—�K^��k � ����,� ���— EXEMPTION
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FROM�����y� �����U|��|0/� 8 ����� P���K8|T � u'
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aaauthorized bythe State ofNorth Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
inanarea ofenvironmental concern pursuant to1oNCACSubchapter 7K.O203.
Applicant N
Address
City ` State zip����_��_
Project Location (County, State Road, Water Body, etc.) '
Type and Dimensions of Project
The proposed project tnbelocated and constructed audescribed This certification ofexemption from requiring aCAK4Apermit iu
above iohereby certified anexempt from the CAK4Apermit re- valid for Q8days from the date ofissuance. Following expiration,
quiroment pursuant to 15 NCAC7K .0203. This exemption to are-examination ofthe project and project site may benecessary
CAK4A permit requirements does not alleviate the neoonohy of tocontinue this certification.
your obtaining any other State, Federal, nrLocal authorization.
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Any person who proceeds with adevelopment without the con-
sent ofaCAK4AoMicialundorthomio1akonunaum[tionthat1ho
development isexempted, will boinviolation cdthe CAK8Aifthere
isasubsequent determination that apermit was required for the
development.
The applicant certifies bysigning this exemption that (1)the ap-
plicant has mad and will abide bythe conditions nfthis exemp-
tion, and (2) a written statement has been obtained f rom adjacent
landowners certifying that they have no objections to the
proposed work.
Applicant's signature \ ' J
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K.0203
4
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that•I own property adjacent to
AL & PEGGY PADGETT 's property
Name
located at LOT# 14 CLUB FOOT CREEK , on
(Lot, Block, Road, etc.)
CLUBFOOT CREEK in HARLOWE/CRAVEN , N.C.
(Water Body) (Town and/or County)
He has described to me at shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
cFF ATTACHED
ignature
Name
Phone Number
03/04/199B 14:47 9196363127 FOLEY AND FOLE,' INC PAGE 04
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,••�•�• rnurr�XTY OWNER ST
A PISRi
I hereby certify that•I own property adjacent to
AL &_PEGGY PADGETT
Name s property
located at Lo
T# 14 CLUB FOOT CREEK
(Lot, Block, Road, etc.) . on
CLUBFOOT CREEK in
(Water Body) L ti'E CRAVEN
(Town and/or Co u TO
He has described to me as shown below the development he is
proposing at that location and I
have no objectio
ns
7 ns to his
proposal I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless Waived -'by me.
X_ I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawin ,of
Proposed
FILLED IN BY INDIVIDUAL PROPOSING D,opM�velopment: (TO BE
A2 { S�t-C SEE ATTACHED
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