General Permits (7228)

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
Address
Citv
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.
Phone Number
State
Zip
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.
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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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

APPLICATION FOR
�-' CAMA
°pJ MINOR
DEVELOPMENT
PERMIT
In 1974, the North Carolina General Assembly passed
the Coastal Area Management Act and set the stage for
guiding development in the fragile and productive areas
which border the state's sounds and oceanfront. Along
with requiring special care by those who build and
develop, the General Assembly directed the Coastal
Resources Commission (CRC) to implement clear regula-
tions which minimize the burden on the applicant.
This application for a minor development permit under
CAMA is part of the Commission's effort to meet the
spirit and intent of the General Assembly. It has been
designed to be straightforward and require no more
time or effort necessary from the applicant. Please go
over this folder with the Local Permit Officer (LPO) for
the locality in which you plan to build to be certain that
you understand what information he or she needs.
Under CAMA regulations, the minor permit is to be
issued within 25 days once a complete application is in
hand. Often less time is needed if the project is simple.
The process generally takes about 18 days. You can
speed the approval process by making certain that your
application is complete and signed, that your drawing
meets the specifications given inside and that your
application fee is attached.
Other permits are sometimes required for development
in the coastal area. While these are not CAMA-related,
we urge you to check with the Local Permit Officer to
determine which of these you may need. A listing is
included on page 2 of this folder.
We appreciate your cooperation with the North
Carolina Coastal Management Program and your
willingness to build in a way which protects the
resources of our beautiful and productive coast.
Coastal Resources Commission
Division of Coastal Management

Locality Permit Number
GENERAL INFORMATION
LAND OWNER
Name fZou s� w ;tee GoG G EE/v G. Ro oc s
Address 1671 A/WZ, e >
City `T State ^f- C',
AUTHORIZED AGENT
Name
Address
Zip z8 S70 Phone C7/9 70-4� —&7&/-
City State Zip Phone
LOCATION OF PROJECT GoT i('.9l�FD,�L) Es : i4TEs SALTY s/•Orc'ES
C�_©4!1A4ZeA11'TY , `f«/7-,5_ ORS T`K!f �192TE.�ET CO. /l <G_.
(If not oceanfront, is waterbody natural or manmade?) Mah.-nacle c--- ,tea/ /G2��i9oi fa
(3dyke SaK—e.!
DESCRIPTION OF PROJECT �raocsE� 3o'�r ems' C/ev.cfea��cv<//.:vcr w/-'fh .o-x i�S'
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard t� Estuarine Shoreline ORW Shoreline Other
PROPOSED USE
✓Residential Commercial/industrial Other
SIZE OF BUILDING IN SQUARE FEET /3 5a ss. �f ,iizs sy,
Size of other impervious or built upon surfaces (such as driveways, etc.) within 75 feet of the shoreline (575 feet
of an ORW shoreline) ,V. 4.
SIZE OF SITE IN SQUARE FEET
OTHER PERMITS MAY BE REQUIRED ...
The activity which you are planning may require
permits other than the CAMA minor permit you
are applying for here. As a service we have com-
plied a listing of the kinds of permits which might
be required. We suggest that you check over this
list with your Local Permit Officer to determine
which, if any, of these may apply to your project.
This is not a requirement of LAMA, only a sugges-
tion to help you complete your project as quickly as
possible.
Zoning, Drinking Water Well, Septic Tank (or other
sanitary waste treatment system), Burning, Electri-
cal, Plumbing, Heating and Air Conditioning, In-
sulation and Energy Conservation, FIA Certifica-
tion, Sand Dune, Sediment Control, Subdivision
Approval, Mobile Home Park Approval, Highway
Connection, Others:

STATEMENT OF OWNERSHIP
I, the undersigned, an applicant for a CAMA minor development permit, begin either the owner of property in
an area of environmental concern or a person authorized to act as an agent for purposes of applying for a
CAMA minor development permit, certify that the person listed as landowner on this application has a sig-
nificant interest in the real property described therein. ' i t ca be des ibellow : (check one)
� ,EJ
�an owner of record title, T' e is v ted ' j �Deed Book
pagein the County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contact or lease, explain below or use a separate sheet and attach to this
application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS
�i
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA permit.
k-
(Name) (Address) y
(1) f3o66v A. do// Rf CGo -"s X4d�v�/rs/WA- %
S Box .74<4, AZe- 7
�or�,:Ect.�tPmD. J�a ho�7`l.)
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(2) /S'd�/� V 19. �� /�� /C f. S go" S� iV PcdVO ✓/y /� • �. 2�S%ZJ Qe� Q �ttiJ� oiy0. �O wPS�
(3) !-r/.
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area which may
be susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
concerning stabilization and floodproofing techniques.
PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
This application includes: general information (this form), a site drawing as described on the back of this ap-
plication, the ownership statement, the AEC hazard notice where necessary, a check for $50.00 made payable to
the locality, and any information as may be provided orally by the applicant. The details of the application as
described by these sources are incorporated without reference in any permit which may be issued. Deviation
from these details will constitute a violation of any permit. Any person developing in an AEC without a per-
mit is subject to civil, cri ninal d administrative action.
This the c, day of 19 cP
01
12,� / X�'P_
Land owner or person authorized to act as his agent
for purposes of filing a CAMA permit application.

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor develop-
ment permit. The drawing may be simple and not necessarily to scale. The Local Permit Officer will help you,
if requested.
PHYSICAL DIMENSIONS
el roads
label highways right of ways
✓label local setback lines
✓label any and all structures and driveways currently existing on property
PHYSICAL CHARACTERISTICS
"� draw and label mean high water mark (MHW)
Alw- draw location of septic tank or filter field
If you will be working in the ocean hazard area:
&,4. draw and label dune ridges (note height)
.✓. A. draw and label toe of dune
,&/A. identify and locate first line of stable vegetation
w A. draw and label setback line under CAMA
M A. draw and label topographical features (optional)
If you will be working in an estuarine shoreline area:
✓draw and label landward limit of AEC
✓ describe terrain (slope)
DEVELOPMENT PLANS
✓draw and label areas that will be disturbed
___Zif a house is to be placed on lot, describe location of house
✓ note size of piling and depth to be placed in ground A-* ,,a er r N•
draw and label all areas to be paved or graveled
describe composition of surface
note and list fully all trees and vegetation to be removed or relocated
show landscaping
NOTE TO APPLICANT
Have you:
*completed all blanks and/or indicated if not applicable?
*notified and listed adjacent property owners?
*included your site drawing?
*signed both application and statement of ownership?
*enclosed the $50.00 fee?
*completed an AEC Hazard Notice, if necessary?
FOR STAFF USE
Site Notice Posted Final Inspection Fee Received
Site Inspections
Date of Action: Issued Exempted Denied Appeal Deadline (20 days)

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AUGUST 5, 1994
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT,
HEALTH AND NATURAL RESOURCES
MOREHEAD CITY, NORTH CAROLINA 28557
ATTENTION: MR. JIM MERCER
RE: RADFOR ESTATES LOT #6
DEAR MR. MERCER:
WITH REFERENCE TO THE ABOVE, PLEASE CONSIDER THIS LETTER AS NOTICE
THAT I HAVE NO OBJECTIONS TO MR. ROUSE BUILDING WITHIN 40' OF THE
BULKHEAD.
THANK YOU.
RESPECTFULLY,
w t7 P,-i
W.F. PARKER, P.E.