General Permits (7707)

J �J
Y CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT ►l
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 Phone Number
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 cc -tif ication 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.
I SKETCH (SCALE: ) I
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A
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.
Y
Applicant's signature
UAMH UTTiciars slgnaTure
ng date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

07/10/00 MON 08:58 FAX [phone] EMERALD ISLE REALTY 16001
�.r�ergCd .isle �'c'�gLt�,
7501,Emerald Drive
Emerald Isle, NC 28594
Rental [phone]
.Sales [phone]
J FAX [phone]
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07/10/00 MON 09:11 FAX [phone] EMERALD ISLE REALTY
fa 002
AllJAC NI' WAKIAN PROPERTY OWNER STATEMENT
(FOR A PIENMOORING PILINGSIBOAIZIfTIBOATHOUSE)
I hereby certify that I own property adjacent to cJ &oi Ntka�, ,s
(Name of Property Owner)
property located at -0 � AD
(Lot, Block, Road, etc.)
on 00LIL etJ:e_f , in 5ux.6 o , N.C.
(Waterbody) (Town and/or County)
He has described tome, as shown below, the development. he is. proposing at that location,
and, I have no objections to his proposal. I understand that a pierlmcoring
_ pd ngsftadifVboattwuse_must beset -back- a rn-ir:imum distance of fifteen
feet'(15'yfrom my -area
of riparian access unless waived by me.
—1— I do not wish to waive the setback requirement.
I .o wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIvfEl
(To be fulled in by individual proposing development)
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Signa e
Print or Type Name
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Telephone Number
Date:

07/10/00 MON 09:11 FAX [phone] EMERALD ISLE REALTY 2003
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWN -ER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: JqA 0stk�,
Address of property:
5VJ-A446LM AC assXXt
(Lot or Stre:t Strett or Road, City & County)
I hereby cetufy that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
/)(, I have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestron PL= II, 15I_8, Hwy. 24, Morehead City, NC, 28557 or call (252) 808.
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags mus be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the li' setback requirement.
fi
Signature
G. BF
if'1
Print Name
q
Telephone Number With Area Code

DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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SENDER:-
■ Complete Items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired_
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the malipfece,
or on the front if space permits.
1, Article Addressed ta:
lJjj - e Oak. �UPf neofe,�U
�'35 IA)kt eL7rc�ssl.: .
f)II04 us&MON /JC aSs�
A. fleceivcd by
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Q Agent
if✓ ❑ Addre
Item 17 ❑ Yes
aiew: Cl No
3, SerAoe i �j�"
RrCentf€ed Mail Q Express Mail
11 Registered Weturn Receipt for Mercherufise
© Irksured Mail ❑ C.O.D.
4. Restrfcted Deliver/? Orra Feel ❑ Yes
2. Article Numb (C y fir rvke label)
'ID g T 3gb0 OUnj( 4,y%8 q
PS Form 3811, July 1999 Domestic Return Receipt 102595-99.PA.1799