General Permits (7290)

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CERTIFICATION OF EXEMPTION ( pp
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FROM REQUIRING A CAMA PERMIT 1
as authorized by the State of North Carolina, { r r tt
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 (,F ttar k Phone Number 393-8So8
Address '141 to,'- C ,de
City �),!,�+'t ; State Pi zip 2 >K1 0
Project Location (County, State Road, Water Body, etc.) (ca:.ff. ,4 (<<+al,1 Y91 f ep„c, Kt —le, A,• fit,
Type and Dimensions of Project rya "07 ;?cr �.F, .a T r d. r /•..
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.
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.
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Applicant's signature
CAMA Official's signature
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Issuing date
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Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

I hereby certify that I own property adjacent to (�x n�� Cz. 's
(Name of Property Owner)
property located at t{'-f ( q+ 0 (V k
(Lot, Block, Road, etc.)
on ���i� , in 00,,-�-kt � p , ljl�-6-7 a N.C.
(Waterbody) (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 by individual proposing development)
S i Qnature
Print or Type Name
c2- n� ~ 3 `l-3- 7a 92
Telephone Number
Date: D d /

To JKf�L�
Date D7- d 5 Time
hile You Were Out
M Cf�t'S Qr
Phone 1393 - ?S U p
Area Code Number Extension
URGENTI
TELEPHONED
CAME TO SEE YOU
RETURNED YOUR CALL
WANTS TO SEE YOU
PLEASE CALL
RUSH
WILL CALL AGAIN
MESSAGE iCe S�Pr %to i D C S k
SIGNED
►71��1 ��l' Reorder No. 01325

4191�
I hereby certify that I own property adjacent to V% eke--, 1(Z � C'�CI I
(Name of Property Owner)
property located at � e & `c-S 511t , lit Q �2tvti�-�-� c t(, p� u' v 1
(Lot, Block, Road, etc.)
on in o�i'2 \4--c-A yN.C.
(Waterbody) (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 by individual proposing development),
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Signature
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Print or Tvpe Name
r-5�-'19'� SsSa$
Telephone Number `
Date: � " Jam— 0 1

DIVISION
ADJACENT RIPARIAN PROPERTY � yy-,�-E ��i �l'�� GEME� T
R NOTIFICATION/WAIVER FGR.tiI
Name of Individual applying for Permit: � CVo Le . . :'" ..... .. ... . ...
Address of Property: �-fq l Pro—©"V'J Q k \r�
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(Lot or Street = Scr'-' or Road, Citv & County)
I hereby cerdry that I own property adjacent to the above reverenced grope-Y. Tne individual
aopiyinQ for this permit has described to me as shown on the attached drawing the deve:oome;,t
t ley are proposing. A desc-.:pdon or drawing, with
eQi:TienSionS, should be provided w -h this
r.
I have no obiecdons to this propos-
If you have objections to what is being proposed, please wr�ie the 1?ivisian of Coastal
Management, Hestron Pla�z II, 151-B, Hwy. 24, Morznzad
Cuy, NC, 28557 or call (2 2) 808-
2808 within 10 days of receipt of this nonce. No resoonsr is considered the same as no ociec.-ion
it you have been notijzed by Cerriyzed Mail.
WAIVER SECTIOY
I nder,tand that a pier, dock, mooring
pilings boathouse. Iir[ or sandbazs r,;�s, be
set back a minimum distance of 15' iiom my area of to waive the setback, ac s-
wa;7 r= ' s uni, ss waived by me. ! ou
you must initial the approp;,a:: biank below.)
do wish to waive the 15' setback rep"ir e-e.t.
I do not wish to waive the 15' setback- reCuirement.
Sign e Date
Pr;nt me G'
Te:ephone Number With Area Code

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