General Permits (8126)

CERTIFICATION OF EXEMPTION � �elr
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, N
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
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
Zip
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other(State, Federal, or Local authorization.
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
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

P 728 621 319
Certified Mail Receipt
No Insurance Coverage Provided
Do not use for International Mail
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Postage
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Special Delivery Fee
Restricted Delivery Fee
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Date. & Address of Delivery
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I%hereby
ycertify that I own roperty adjacent to
( /4#400C 's property
�j Name
located at on
�j Lot, BXock,Road, a .) _
�n /C7�jC��a rt % � )C NT—
(Water Body) (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 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 that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TOO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Sr'ature
�! 1x;19 o 1a
Name
Phone Number
O )rap rr
MAY 18 1992 ;''

Official Business
! SENGiR: I also wish to receive the
• Complete items 1 and/or 2 for additional services.
*011 - ..Complete items 3, and 4a & b. following services (for an extra
• Print your name and address on the reverse of this form so fee):
that we can return this card to you. 1. ElAddressee's Address
• Attach this form to the front of the mailpiece, or on the
back if space does not permit.
PENALTY FOR PRIVATE • Write "Return Receipt Requested" on the mailpiece next to 2. ❑ Restricted Delivery
USE, $300 the article number. I Consult postmaster for fee.
3 Article Addressed to: 4a. Article Number
Print your name, address and ZIP Code here 0
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T ���� • /' Na' ❑ pegistered ❑ Insured
^Jibes e( cv pO �nx (Q�� Certified El COD
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Form 3811, October 1990 *U.S.APO: 1990-273-ast DOMESTIC RETURN RECEIPT

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Dear ON
This 41eer is to notify You as an adjacent riparian landowner of
Mr./Mrs. T7 -S -+L �-�alans o construct _
on their property located at _
in GR`� J6- �— _, NC. The sketch on the reverse
side accurately depicts the proposed construction.
Should you have no objections to this proposal, please check the
statement below, sign and date the blanks below the statemen—
t,
and return this letter to: n1 C 3 S• GQJ
as so n as possible.
Should you have objections to this proposal, please send your
w.itten cc- ^ts to the NC Division of Coastal Management, P. O.
Sox 769, Morehead city, NC 28557. Written comments must be
received within ten (10) days of receipt of this notice.
Failure to respond in either method within ten (10) days will be
interpreted as no objection.
Sincerely,
--------------------------------
I have no objection to the project as presently
proposed and hereby waive that right of objection as
provided in General Statute 113-229.
I have objections to the project as presently proposed
and have enclosed comments. / /l
Signature
DATE:
I MAY 1 819V
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CERTIFIED MAIL
RETURN RECEIPT RE9UESTED
Dear
This letter is to notify you as an adjacent riparian landowner of
C.L �✓ lans to construct
Mr./Mrs.„[.r✓
on their property located at
NC. The sketch on the reverse
side accurately depicts the proposed construction.
Should you have no objections to this proposal, please check the
n and date the blanks below 4/C-the statement,
statement below, sigf
and return this letter to: �J ht 'et. S /a�f/
r
ass sdo,f as possible.
Should you have objections to this proposal, please send your
written comments to the NC Division of coastal Manage.oentT1P. be
m
Box 769, Morehead City, NC 2b557• '� ittct' c�' -
received within ten (10% days of receipt of this notice.
Failure to respond in either method within ten (10) days will be
interpreted as no objection.
Sincerely,
--Ii-----------------
I have no objection to the project as presently
/ 1
proposed and hereby waive that right of objection as
provided in General Statute 113-229.
1 have objections to the project as presently proposed
and have enclosed comments-.
signature J
DATE: L
V
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REGISTERED N 3 4 POSTMARK
Reg. Fee Special $
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_W q� MAY 18 1992
PS Form 3806, RECEIPT FOR REGISTERED MAIL (Customer Copy) L.i h:►'�S t
April 1991 (See Information on Reverse/