General Permits (7083)

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Applicant Name
Address
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the Coastal Resources Cotatmission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
City State
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.
Phone Number
Zip
This certification of exemption from requiring a CAMA permit is
valid for 60 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
/ ( ` ,- -i/1/
Issuing date '%
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

09-06-54 13: 4`l
GRAFTON MARINE CONST.
Jim AAWAe
GR RONMARIN . COAMUCHON
105 sFA HORSE DRIVE
SWANSBORO, NC 28584
(919) 3;3-+6137
FAX (9I9).393-7010
ADJACENT RIPARIAN PROPERTY OWNER
I lreby certify that I own properly adjacent too _ 's
lomwd at
(LCft, BLOCK. ROAD, ETC.) ��
S :f in .._ w-91-r 1 NORTH CAROLINA,
(WATER BODY) (TOWN AND/ OR COUNTY)
prq* y MMer dcc Ud to me the pr vm,--d d (g*M-1t is sho" indmWift-
i gbject to pn po" project.
(DO) (DO Wn)
I mod drat a pier must be get back a distance cif fifteen (15) feet from my
a= of vq, wm, unkss waviad by mc.
I & Z wish to waive that setback ent.
(DO) (DO NOT) `tfi
DFACRW77ON of DRAWING SI. BE
PIER I�vus e
BOAT LYFf
—B1TL AD
LHMIDECK OVKRMAD
LI f/ROOF OVERHEAD � C�
vr� 4�
(SIGN TURF-)
(NAME)MINT
lco-! - r9 CQ "
(PHONE NUMBER)
S`
((Nb))�t
s
ADta►REss} '
(CITY, STATE, 23 P CODE) `�►
(HQMF PHONE)

09-OE-94 13: 4`1
GRAFTON MARINE CONST.
089 P02
B�u;I m„�ti
J 1 - 3330
105 SEA HORSE DRiYE
SWANSBORO, NC 28584
[phone]
FAX (919).3"-7010
ADJACENT RIPARIAN PROPERTY [OWNER
I hereby certify that I own property adjacent to
located of
an
jj
(LOT. BLOM ROAD, ETC.)
_ d Z2r.f .Z'Y _ m --- NUR7H CAROLINA-
(WATEFL BODY) (TOWN ANIV OR COUNTY)
Prop u ty awvmtr h1p do nbcd to nw the prupohed development ws shown in drawing;
I objcct to ptaa►pow+ed project.
(DO) (DO NOT)
I urdkmmd that a pier must he set buck a minimum distance of i'ftecn (15) feet from my
at ut of npanm urrlCea waviod by me.
I , =wish to waive that setback re u=wnt,
(DO) (DO NOT)
D98CRW770N OF DRAWING (h�LL157 BE I� II�R
,PIER
H�UAT LIFT
LIFTIDI CK OVERHEAD
LIFT)ROOF O F.AD
r
t
,riOA �i01 £1i _ K31.1-111
(NAME) PRINT
(PHM E NUM$ER)
FM FSOPERTY OWNER LM
--W)Fha e-1
G Ann SS) Q
sf
(Taff STATE, ZIP CODE) y
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(H PHONE) Jai
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