General Permits (7223)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
. as authorized by the State of North Carolina,
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 j0-, Phone Number / / 1
Address opt 10(-� h -a`
City '; ! - f
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.
State
- zip. -2 S
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 ��� �j 7—/4 (SCALE: )
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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
10 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.
Applicant's signature -
CAMA Official's signature
3-1�- --i y
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

11aT ;(ZT[� RIP11RiArJ I_ ZTy ���i_7���TL�i�tC
I hereby certify t1Tat I own prroperty adjacent to r�
c:ro.rvrty looted at A-
�j
on t lot, block, road, etc .
1 rW�r
(body of water) in
rlortli Carolina in Pamlico County. The Proposal has been described to me
as sham `;
the dcveloFxrent, er bulkhead/structure, and the proposed location, and I have no
objections to the Proposal.
one)
P Posal. I understand that if the development is a pier, it must
bo sc� hack a minimum distance of .1 feet from my area of riparian access unless %v livod
h)' m^• j d do nol wish to waive that setback requirement.
(circ I a one)
Description and/or drawing of proposed development: (to be filled in by individual
ProPOsing development.) INDICATE THE SIZE AND
I)ISTik'CC BLM-M24 EACH PROPERTY LINE LOCATION OF THE STRUCTURE A.'�ID THE
sheet., the adiacent AI4ID Z�iE �1'1'ER. Draw in del +►'� sn se ara e
his paper. veer must initial and date th�`t��''s_eet; signature on
11
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(0�7i-Ti^.al rust be ictain`d in tho Insg2cticn flei:arC nt)

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,� 5 ' t one - a4ovq ! (A e.

AD�7 �CT.•cTE' I2TP11RIAi� j�f��P:;,ZTy O�n�t i`I'�'1TL';;'•iI;tVT
I Hereby certify that I own Property adjacent to r--
r:rO.rx'rty located at t j
on ,1 (lot, block, mad, etc
(body of Boater) in North Carolina in Pamlico County. The P toV�n)
roPosal has been described to me as sho%,n belot.j.
the dcveloprent, a L /bulkhead/structure, and the proposed location, and I have no
objocti.ons to the-- ircle one)
proposal. I understand that if the developnent is a pier, it must
bc set tuck a minimum distance of 15 feet from my area of riparian access unless vvc,ivod
I do do no I wish to waive that setback requirement.
(circle one)
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Description and/or drawing of proposed devel
Proposing development.) INDICATE THE SIZE AND t� ( to be filled in by individual
l)i STikrCC I3L'Ii-TM EACH PROPERTY LINE LOCATION OF THE STF2UC'Ii1RE A, D THE
shear, thn adjacent AND THE �1TER. Draw in 1. 'QR dt S?,�t se ara e
-�5 paler. !?r vner must initial and date th`t s eet; signature on
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