General Permits (7229)

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 Commissioned
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name ✓/i?-ham f 1' /S h _c�
Address c, -P
City -
Project Location (County, State Road, Water.Body, etc.)
rt.
State
Type end 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.
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.
Phone Number
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

I hereb certify that .I own property adjacent to
©� 's property
Name
located at Aar 5'6 S `
on
(Lot, Block,. Road, etc.)
rzby t, cg f= in /y tic) �l1 t I C cl iJ N . C .
(Water Body) (Town arid/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.
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
�, Phone Number

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I hereby certify that -I own property adjacent to
"O.J 1' &A t- Ka frlf fM 's property
= Name
located at Fy ., on
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(Lot, Block,_:Road; etc.).
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rater Body) (Town a d;or 4ounty)
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 (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
a Phone Number

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