General Permits (7082)

4
CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, tt
Department of Environment, Health, and Natural Resources and the Coastal }
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .02
Applicant Name
Address
City r ,
Project Location (County, State Road, Water Body, etc.)
C: o
-1-.(-, "� s
State
C.
nCT 11 199
Phone Number
Type and Dimensions of Project ' , ! , 4 ''1 Tl ' " v '''I, -
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.
Zip
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.
SKETCH (SCALE: )
+
i
T r titi
{ _4 �...
ILL
i
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
Welopment.
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.
~ A )icant'ssignature 1.
CAMA Official's signature
Issuing date I '7. / � - !y
r fF
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

. . Y �
State of North Carolina
Department of Environment, A,
Health and Natural Resources + •
Division of Coastal Management
James B. Hunt, Jr., Governor p E H N R
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
September 13, 1994
Mr. James Fish, Jr.
4916 Theys Road
Raleigh, NC 27606
Dear Mr. Fish:
Attached is a Certificate of Exemption From Requiring a CAMA Permit to construct a
pier off SR1346 and Star Church Road, Marshallberg, on Sleepy Creek, in Carteret County,
NC.
In order to validate this permit, please sign all three (3) copies as indicated. Retain the
yellow copy and the attached regulation (7K .0203) for your files and return the blue and green
signed copies to us in the enclosed, self-addressed envelope.
Your early attention to this matter would be appreciated.
Sincerely,
(L) V'C�� �� . S�
Charles O. Pigott 51
Field Representative
COP/dh
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier 1 11-12-09
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's property located at
(Name Property owner)
(Lot, Block, oa etc.)
n - in N.C..
on own and/or County)
(Wate y)
He has described to me, as shown below, th
e development he is
proposing at that location, and, I have no objections to his
proposal.
-----------------------------
(To be f
OR DRAWING nr PROPOS
by individual propos
S
Cc
VELOPMENT :
evelopmen
x
H
Signature
Print or Type Name
Telephone Number
SIFF 12 1
"M'A----------------�, ,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
F�,.�aoa.di
I hereby certify that I own property adjacent
's property located at
;Name of Property V�qner
(Lot, B
(Wat rody)
He has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
. C'.
DESCRIPTION AND OR DRAWING OF PROPOSED
DEVELOPMENT:
(To be filled i by individual proposing development)
CC ��
-/O ( (/
Signature
Se -F4 CW
E C�SQu / 2 A?L- il/l`. � Print or Type Name
Telephone Number