General Permits (7783)

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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 71K .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 �T y ?
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: )
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.
Applicant's signature
CAMA Official's signature
Issuing date
el ,^ rr^
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

-
0 PIERIMOORING PILINGS/BOAM1,71BOATHOUSE
I hereby ce \ at I own property adjacent to
(Name of
property located at � C
(L t, Block, Ro , e .)
on I in
(Waterbody) (Town and/or County)
:rty Owner
12
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2 �I7
• . N.C.
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/boadifr/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 do wish to waive that setback requirement.
DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPIVMNT:
(To he ftUed in by individual proposing development)
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Signature
S Print or Type Name
7 I �
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Telephone Number
Date: L

ADJACENT R.I )ARIAN PROPERTY OWNER STATEM=
(FOR A PIER/MOORING PILINGS/BOATLIF (BOATHOUSE)
I hereby certify that I own property adjacent to
(Name of perty Owner
property located at ),4j/ , � C � ��;�0�L-
(Lbt, Block, Ro , e .) Z -1 7
on in /''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. I understand that a pier/mooring
pilings/boatliftiboathouse 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 Lo wish to waive that setback requirement.
DESCRIPTION AND/OR DRAW NG OF PROPOSED DEVELOPMENT:
(To be fdIed in by individual proposing development)
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Print or Type Name ss��
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Telephone Number
Date:

GAGE DISPOSAL SYSTEMS
-) BY A COMMUNITY WASTE" >TER COLLECTION,
STEM AS APPROVED BY THE CARTERET COUNTY
TION, CARTERET COUNTY HEALTH DEPARTMENT.
'ALL BE OWNED AND OPERATED BY THE NELSON
IATION, INC. EACH LOT SHALL BE REQUIRED TO
EMENTS PERMIT". ALL LEGAL DOCUMENTS SHALL
ISSUANCE OF AN OPERATIONS PERMIT.
RECTOR OR HIS
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FLOOD CERTIFICATE
THIS PARCEL SCALED WITHIN ZONE "A4"
B � 1 370043 034050C INSURANCE
8/119/95 AP NUMBER
ESTABLISHED f3Y F.F.M A