General Permits (7189)

CERTIFICATION OF EXEMPTION 1
FROM REQUIRING A CAMA PERMIT f
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as authorized by the State of North Carolina, v �1 '� �
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name "�Phone Number
Address r,t r 'f
City _i4f, r State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project T"� ,�. � J(, 4 pe- 4 ' "- L / !" / . If ` r2-
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.
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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.
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.
Applicant's si nature Y
P 9'
LAMA Official s signature
7 - > if
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

State of North Carolina
Department of Environment, XV�KTA
Health and Natural Resources 107
Division of Coastal Management AM
Ik
James B. Hunt, Jr., Governor p E H N FI
Jonathan B. Howes, Secretory
Roger N. Schecter, Director
September 13, 1994
Mr. Rudolph Nelson
P. O. Box 364
Beaufort, NC 28516
Dear Mr. Nelson:
Attached is a Certificate of Exemption From Requiring a CAMA Permit to construct a
pier off SR1371 (Stacy Loop Road) and a canal off Britts Bay, in Stacy, Carteret County.
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,
Charles O. Pigott
Field Representative
COP/dh
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier it 11-12-09
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71

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
�• //tom/S Iyc S 's property located at
(Name of Property'Owner)
Z
(Lot, Block, Road, etc.)
on _ `l��C in J!/G'�i .
(Waterbody) N.C.
(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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in b_ y in ividual proposing development)
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Telephone Number

9197285333 IIELSOhd YRCHT SALES
886 P8-1 APR 22 '94 13:50
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that-1 own property adjacent to
f UTJfJI_ 'i`� Q �/E'4 H % �G See-1 Is Property
J Name //��
located at /� 0% j/�cw 6we 6o / /3 _ _, on
(Lot, Block, Road, etc.)
%-3n eGYzs 6 in r 5 c!� , N.C.
(Water Body) (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 must be set back a minimum
distance of fifteen feet (15') from my area of riparian access
unless waived by me.
I do not.wish to waive that setback requirement.
.,/ Z do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FYLT.ED IN BY INDtVIDUAL PROPOSING DEV=PMBNT)
009
,1,441) �K
a�tjseP�i SigrY�ture
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Phone Number