General Permits (6572)

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^��_��^�U�U����U���U ��� �`��N�����K���U
CERTIFICATION ��-������ � ����,� ���- EXEMPTION
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��(�0Y ��/�U|�|��� �y~�K8& ���YN|T
FROM ^~�'"' REQUIRING "'`~� "` ~~~�'"''` PERMIT
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uoauthorized bythe State ofNorth Carolina, '
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
inanarea ofenvironmental concern pursuant tn1sNCACSubchapter 7K.U2U3.
Applicant Name 6�xV I -I- Phone Number
. �
Address
city State zip
Project Location, (County, State Road, Wat ' er Body, etc�
Type and Dimensions of Project 7
The proposed project tubelocated and constructed oadescribed
above is hereby certified as exempt from the CAMApermb re-
quirement pursuant to 15 NCAC 7K .020.Thisoxemptionto
CAMA permit requirements 6noo not alleviate the necessity of
your obtaining any other State, Federal, orLocal authorization.
This certification cdexemption from requiring oCAMApermit is
valid for O0days from the date nfissuance. Following expiration,
are-examination ofthe project and project site may bonecessary
tocontinue this certification.
SKETCH, (SCALE:
�
Any person who proceeds with odevelopment without the con-
sent ofoOAMAcffkcialundarthemistakenossumptiontha1the
development isexempted, will bainviolation ofthe CAMAif there
imasubsequent determination that apermit was required for the
development.
The applicant certifies bysigning this exemption that (1)the ap-
plicant haamadondwiUabidebyth000nditimnoofthioexomp'
tion.ond(2)owrittunstatementhaoboonobtainodfmmodjaoort
landowners certifying that they have no objections to the
proposed work.
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Applicant's *gnature
CAMA Official's signature
Issuing date
-
Expiration date

M 100'd 9LSZ'ON XH/X1 L6:60 86/LZ/LO
ADJACENT RIPARIAN PROPERTY OWNER STATEAIENT
(FOR A PIEWMOORING F)MG,SIBOATZIFTIBOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner) ^
ply located at
(Waterbody)
'S
N.C.
(Town and/or County)
He has descri-bed 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/utooring
piiings/boatiiftlboathouse 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 the setback requirement.
I AQ wish to waive that setback requirement.
DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPMENT':
(To be failed in by Lmavidued proposing development)
Signature
Print or Type Name
2 - Z- (J'-
Telephone Number
Date: 7 -
TO'd 658E.Ot7E 01 0222 L.t'E 6T6 OJ3-i360W W0Q WOZid 8i7:0T 866T-LE--1nf

JUL-27-1992 10:49 FPDM DCM MDPEHEAD 919 247 3330 TO 2402eG9 P.02
ADJACENT RIPARIAN PROPEATT OWNER STATE MF-NT
(IAOR A FIERIMOORING PILINGSIBOAMIFTIBOATHOUSE)
I hereby certify that I own property adjacent to 's
(Name of PToiTerty Omer)
pmperty located at
(Lot, Block, Road, etc.)
on � in 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
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION ANMOR DRAWING OF PROPOSED DEVELOPMENT:
(To be, fined in by individual proposing development)
&D
Signature
Print or Type Name
Telephone N ber
I
Date: / c
i
TOTAL P.02
07/27/98 09:47 TX/RX N0.2576 P.002 0