General Permits (7319)

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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
City
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 1
_ 71
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 (SCALE: i )
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Your project is subject to the NC Division
of Water Quality Neuse River Buffer Rules
due to its location within the Neuse Basin.
Please contact Deborah Sawyer at
252-946-6481.
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.
lr'
Ou _
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

.aPrtacATroN FOR
LAMA
MINOR
DEVELOPMENT
PERMIT
In 1474, 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
GENERAL INFORMATION
LAND OWNER
Name
Permit Number
Address �C7� ma, Y' c'_ I 1Z
G r i'v
City 2 G�A f Pc"C c2 c-0 State tl I Zip Phone
AUTHORIZED AGENT
Name A OL rej —D L-) \ C\
Address
r,
r`IVe
\
City �G5-I Mead U LI) State Zip /451.5-Y Phone %3 % 4J-5 6
LOCATION OF PROJECT
(If not oceanfront, is waterbody natural or manmade?) n Ci tc,t t`a-f
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard
P70SED USE
Residential
Estuarine Shoreline
Commercial / Industrial
ORW Shoreline
Other
Other
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT -UPON SURFACES (such as driveways, etc.) within 75 feet of the shoreline (575 feet
of an ORW shoreline)
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING
SQUARE FOOTAGE OF SITE J �{
OTHER PERMITS MAY BE REQUIRED:
The activity you are planning may require
permits other than the CAMA minor
development permit. As a service we have
compiled a listing of the kinds of permits that
might be required. We suggest you check
over the list with your LPO to determine if
any of these apply to your project.
Zoning, Drinking Water Well, Septic Tank
(or other sanitary waste treatment system),
Burning, Electrical, Plumbing, Heating and
Air Conditioning, Insulation and Energy
Conservation, FIA Certification, Sand Dune,
Sediment Control, Subdivision Approval,
Mobile Home Park Approval, Highway
Connection, and others.

STATEMENT OF OWNERSHIP
1, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in
an AEC 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 significant interest in the real
property described therein. This interest can be described as: (check one)
�n owner gr record title Title is vested in (;& ry n n , see Deed Book
page in the 4,-t- County Registty 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 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.
(Name) (Address)
(1) QY\ 1 C.h01 e l C3 Q f4eccf '� e f-
(2) WEV6r'AQau5�j-'Q '� c �' 90019U
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE.I.JAZARD AREAS:
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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, criminal and administrative action.
This the. % day of -4 U 1
Lando er o rson authorized to act as his agent
for p se ding a CAMA permit application.
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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
label 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
draw location of on -site wastewater system
If you will be working in the ocean hazard area:
draw and label dune ridges (note height)
draw and label toe of dune
identify and locate first line of stable vegetation
draw and label setback line under CAMA
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
if a house is to be placed on lot, describe location of house
note size of piling and depth to be placed in ground
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 appplication 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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GENERAL AREA OF STABILIZATION
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ACTIVITY. ACTUAL LIMITS TO BE SET
+ BY CAMA. PROCESS WILL BE REGRAD
UL S NE USE RIY, ING SLOPE TO PRE -STORM CONDITION
MAX. SLOPE OF I TO 1.5, DEPOSITING
FILL MATERIAL AS NEEDED TO COVEI
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s 6F FOOT DEEP TRENCH AT TOE OF SLOPE
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n� \ �9 A�90, 9�Q FABRIC, INCLUDING TRENCH. INSTALI
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c�9 } IAL OVER STONE TO PROVIDE PLANT-
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at /t)f ?a' SCt r)d(I Po/�T —`2/ (, 5C'��� -� r
(lot, blo k, road, etc)
on ive� in _
(body of water) (town)
North Carolina in County. The proposal has been described to
me as shown below; the development, a pier/bulkhead/structure, and the
(circle one)
proposed location, and I have no objection to the proposal. I under-
stand that if the development is a pier, it must be set back a minimum
distance of 15 feet from my area of riparian access unless waived by me.
I do/do not wish to waive that setback requirement.
(circle one)
*************************************************************************
Description and/or drawing of proposed development: (to be filled in by
individual proposing development). INDICATE THE SIZE AND LOCATION OF THE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND THE WATER.
(Original must be retained in the Inspection Department)
"1
Date
E J
_ 01 t 11-----
Name
(Please Print)

3
1 MAXIMUM SLOPE
PI ANTINC;S
TYPICAL CROSS SECTION
Dimensions may vary subject
To field conditions.
RI DD�G .
SANDY POINT BEACH STABILIZATION
CARTERET COUNTY
DATE: __8 _15 _00___
JOB NO. _2000149
SCALE: -- i_=5'____
NORTH CAROLINA
ROBERT M. CHILES, P;E.
ENGINEERS AND CONSULTANTS
NEW BERN, NORTH CAROLINA

FROM : G DUtlll FH:r: 1'10. . 5-165I99-281 Huy. 24 _000 09:5_Hf9 P1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Y t1ercby certify tttac I own property «djac 'rlt to r
propert.v located at _ f % 2- 612 1n-f f
(lot, block, road, etc)
on l PI -<- in
- (body of wa ei) (town)
North Carolina in0.�County. The proposal has been dEscribed r-o
me as shown below; the development, a pier/bulkhead/structure, and the
(circle one) -
proposed location, and I have no objection to the proposal_ I under-
stand that if the development is a pier, it must be set back a minimum
distance of 15 feet from my area of riparian access unless Waived by me.
I doldo not wish to waive that setback requirement_
(circle one)
Description and/or drawing of proposed development: (to be filled in by
individual proposing development). INDICATE THE SIZE AND LOCATION OF THE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LIRE AND THE WATER.
(Original must be retained in the Inspection Department)
J
Signature
AVOST-
Dare .
Rose,
Name (P1easF princ)