General Permits (7171)

_ CERTIFICATION OF EXEMPTION -K/(%
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, C"d�
Department of Natural Resources and Community Development and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
Address
City State Zip
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
0velopment.
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 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
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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CARTERET COUNTY COURTHOUSE
CENTRAL PERMIT OFFICE OF
COURTHOUSE SQUARE
BEAUFORT. N. C. 2851 6-1896
728-8545
BUILDINGS. MOBILE HOMES. ELECTRICAL. PLUMBING. MECHANICAL
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that own property adjacent to
,/J 0Al /, /;1, tL r Uil Y--
'A7.4A / J. s property
(Name)
located at0& 7/6 �,�GL'- 49 % on
('Lot,' Block, Road, etc.)
�iLFS C�fE.� in E7 �� �.</�
�N.C.
(Water Body) (Town and/or County)
He/She has described to me as shown below the development he/she is
proposing at that location and I have no objections to his/her
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)
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Name
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Phone Number

CARTERET COUNTY COURTHOUSE
CENTRAL PERMIT OFFICE OF
emmmadamm
COURTHOUSE SQUARE
BEAUFORT. N. C. 2851 6-1 a98
728-8545
BUILDINGS. MOBILE HOMES. ELECTRICAL. PLUMBING. MECHANICAL
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
�1Te�✓ L, 9��i7�//� y � %eCG� L � 0 G%i
(Name)
's property
located at / Z � 4 el<' %/4 46c 417
(Lot, Block, Road, etc.) , on
-S A L F S C/'FZ-Xe in C41% yp �'�G�,�%
(Water Body) N.C.
(Town and/or County)
He/She has described to me as shown below the development he/she is
proposing at that location and I have no objections to his/her
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)
Signature V 0 cl
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Name
Phone -Number