General Permits (7531)

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 e llI r % P !�_ %c < _ Phone Number, ?Y' f/
Address
City State Zip
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.
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.
Applican_s`signature
CAMA Official's signature
or b
Issuing date
lea3e7Jk7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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GEORGE M. MITCHELL, III NCDL 3817279 4142
KELLY G. MITCHELL NCDL4904100s
919-772-4215 — I �D% 66-112/531
8104 RHODES ROAD 13004
APEX, NC 27502-7409
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BRANCH BANKING AND'
RALEIGH, NORTH
':053101120-.1303 �SS'� 4L4
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ADJAC:EiN RIPARL- .-'N PROPERTY 0"NER STATELE-'Nl
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
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I hereby cc.,-tiry that I own property adjacent to /'w
Name of Property Owner)
property located at
(Lot. Block, Road, etc.)
on , in-%.C�t.c</mac
(Wateriiody) (Town and/or County)
He has described to me, as s":own below, the development he is proposing at t, at location,
and, I have no objections to his proposal_ I understand that a pie -;'mooring
pilings/boatlift/boathouse must be s::pack a minimum distance of flfteen feet (l5') from my area
of riparian access unless waived by :-ne.
I do not wish to wai-:e the setback repuire:nent. � rCOXZS�T-ALMA-K�6
o2Sa wish to waive '=at setback recuirem,ent.EMEtJT
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DESCRIPTION AND/OR DRAWDiG OF PROPOSED DEVELOPMENT:
(To be filled ir. by individual proposing development)
Print or Type Narne
Telephone Number
Date: ��~

ADJACEIN T RIPARL-�-N PROPERTA' 0"NER STATE:: LEE
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby cer-dfy that I own property adjacent to GQ P if G -P// 's
(Name of trroperty Owner)
property located at 16-_3 C �1 n I�°
(Lot. Block, Road, etc.)
on SDy �yo( , in = G't C Z5&gC G► , N. C.
aterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at t,.at location,
and, I have no objections to his proposal. I understand that a plE=oorn
piIings/boatlift/boathouse must be s:.: ,ack a minimum distance of fifteen feet (15') from my a: -ea -
of
riparian access unless waived by me.
I do not wish to wa:e the setback reouirement.
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I da wish to waive t: E setback re..n uirement.
SEf' 1 0 2002
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L5 E%OASiAiMANAGEMENT
DESCRIPTION AND/OR DRAWr G OF PROPOSED DEVELOPtifE`T:
(To be filled ir by individual proposirz, development)
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Signature
Chg e psi 6ties
Print or Type Name
d� 5-5
Telephone Number
Date: q " —n