General Permits (7204)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
o�
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 , c ��, /,YV 1-1171
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
evelopment.
he 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.
>,c
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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ADJACENT RIPARIAN PROPERTY OWNER STATEI.ENT
(FOR A PIER) �
I hexeby certify tha -•I own property adjacent to
—�
's property
Name
located at zz
d l"
on
(Lot, Block, o d, etc.)
in
(k'ater Body) (Town and/or County) N.C.
lie has described to me as shown below the development he -is
Proposing at that location and I have no objections to his
Proposal. 3 understand that a pier must be set back a minimum
distance of fifteen feet 05') from my area of riparian access
unless waived by me.
3
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
F'I 7 a IN BY I N'DIVI DUAL PROPOSING DEVII;OP Ia,-T )
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ignature
aHPaAF,S 000 5 i
Phone Number

TO WHOM IT MAY CONCERN
REF ; BOAT LIFT INSTALLATION BY ZDENKO and DOREEN PEROS.
I LILIANE M BURNHAM OWNER OF LOT 16 SPOONERS CREEK NORTH
PARCEL I.D. 13016W0116 HAVE NO OBJECTIONS TO THE PEROS
BOAT LIFT OR IT'S INSTALLATION AT THEIR ASSIGNED SLIP.
LILIANE M. BU
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