General Permits (7533)

1..'
CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT fi;
as authorized by the State of North Carolina, 2
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
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.
KETCH (SCALE: )
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.
1
Applicant's signature
CAMA Official's signature
uing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF COASTAL MANAGEMENT
January 19, 2000
David Dixon
P.O. Box 274
Oriental, N.C. 28571
Dear David:
Attached is a Certificate of Exemption From Requiring a CAMA Permit to install a 5' X
28' "side -to" platform as shown, remove the remnants of a previously existing dock
damaged by storms, at your property off Midyette Street, Oriental.
In order to validate this permit, please sign all three (3) copies as indicated. Retain the
yellow copy and the attached regulation (7K .0203) for your files and return the blue and
green signed copies to us in the enclosed, self-addressed envelope.
Your early attention to this matter would be appreciated.
Sincerely,
M. Scott Jones
Coastal Management Representative
MSJ/rcb
Enclosures
MOREHEAD CITY OFFICE
HESTRON PLAZA 11 151-6 HIGHWAY 24 MOREHEAD CITY NIC 28557
PHONE [phone] FAX [phone]
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/1 O% POST -CONSUMER PAPER

ADJACE ARIAN PROPERTY OWNER STATEMENT
(FOR PIE OORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to f) A o J J P 0 A o")
property located at
Aliv
(Na.�me of Property Owner)
f &AJ off t��r � 1.
I
�^ L (Lot, Block, Road, etc.)
on C.._f1 nP (,gEF�C , in 0g-rEti �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. I understand that a pier/mooring
pilings/boatiift/boathouse 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 the setback requirement.
JAI N 12 2DD
I dQ wish to waive that setback requirement.
G�-f a
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Signature
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Telephone Number
Date: 0 3 — Z&64,

ADJACE PROPERTY OWNER STATEMENT
(FOR PIER% ORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
)040 d P io i x0n0 `s
(Name of Property Owner)
property located at 9, U c-- kx q J
o / "�d ' Ef , / � s
(Lot, Block, Road, etc.)
on 6mjoCkEEF- , in Q21En71A� , 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. I understand that a pier/mooring
pilings/boatlift/boathouse 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 the setback requirement.
I da 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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(z,c6A tS)
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Signature
N6tC D l�O L/y/j
Print or Type Name
as a.-ayy-v-/s /
Telephone Number
Date: 1 "9- 1"q 0 % Cj