General Permits (7725)

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
This c�-tification 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
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.
,c-
nt's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

0
RALEIGH PEDIATRIC ASSOCIATES, P.A.
William C. Hubbard, MD, FAAP
Wallace D. Brown, MD, FAAP
Jerry C. Bernstein, MD. FAAP
Sharon M. Foster, MD, FAAP
J. Randy Hedgepeth, MD, FAAP
Karen A. Kartheiser, MD, FAAP
Walter T. Koscielniak, MD, FAAP
Melinda C. Taylor, MD, FAAP
Robert C. Helms, MD, FAAP
John W. Rusher, MD, FAAP
Jeffrey C. Johnson, MD, FAAP
James W. Britt, MD, FAAP
Candace L. Boyette, RN, FNPL
Sandra C. Bunting, RNC
4905 Professional Court
Raleigh, North Carolina 27609
Telephone [phone]
Fax [phone]
800 Benson Road
Garner, North Carolina 27529
Telephone [phone]
Fax [phone]
8025 Creedmoor Road
Raleigh, North Carolina 27613
Telephone [phone]
Fax [phone]
March 7, 2000
Mr. Scott Jones
Coastal Management Representative
North Carolina DENR
Morehead City Office
Hestron Plaza II
151-B Highway 24
Morehead City, NC 28557
RE: Neuse River Property, Arapahoe, North Carolina
Dear Scott,
I received the permits for my property and Barry Poe's property. I have
forwarded the permit on to Mr. Poe, with instructions to sign all three copies and
return the yellow and pink copies to you. Before I return my permit copies, I had
planned to have approximately 75 feet of rock wall, as indicated on the map that I
sent to you last week. The permit calls for approximately 50 feet of rock wall, and
I wanted to make sure this would not create a problem if I, indeed, ended up with
75 feet of rock.
Enclosed is a check for $50.00 which represents the permit fee for Dr. Hubbard's
property.
Please call me at your convenience to clarify the permit on my property before I
sign and return the copies.
Very truly yours,
ohn Rusher, M.D.
JR/mw
Enclosure

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F r: g 2 2 2000
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY` OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: Wway la, Mu) " (� -9` PnF--
Address of Property:
2.3ga Aoa1A Vv& Pa sua
(Lot or Street #, Street or Road, City & County)
I hereby certify 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 propose 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 Plaui II, 151-B, 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.
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Print Name
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Telephone Number With Area Code
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (3 t-A A y J) o. (P is
(Name of Property Owner)
property located at 2 c d 1,3 EN (V E I Zr 14 L g C el=
(Lot, Block, Road, etc.)
on C� C- U S 4E (-)— c v E /Z , in P47?1 L (c © Cy n(l—�' , 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)
re
Print or Type Name
TeYephone Number
Date: 2 ao