General Permits (8128)

CEhTIFICATION 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/ i ;r: f,' r~y� ,.� / Phone Number��
Address
City - State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Projects �!
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 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:A /c/,
)
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
0 velopment.
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.
signature
UAMA Uttiaal's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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S � •%3 Z CARTI—RET CAPE CARTERET WHITE OAK
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WSTERED D SURVEYOR •.,,— �N NO. ► n _ 4U 14 NDVENM3ER, 1989- 3o7- - CC.
SUVED BY DATE jOhn p. mclean engineering associates
ossETT 10 NOVEMBER 1C)139 F,ngint rhig SurvcvinR Land Planning
FIELD BOOK S ) E '- fj DRAWN BY 101 MANATEE STREET CAPE CARTJRET SWANS5oRO N.C. 2e5e4
PAGE 39 919 - 393 - 129

IM,PORTAF'T
I
To
Date�Time
�WILE YOU WERE OUT
of Phone 1' (7
- l 91
AREA CODE NUMBER EXTENSION
Message
igned
TELEPHONED
PLEASE CALL
CALLED TO SEE YOU
WILL CALL AGAIN
WANTS TO SEE YOU
URGENT
RETURNED YOUR CALL
N.C. Dept. of Environment, Health, and Natural Resources
v �v� Printed on Recycled Paper

TOWN OF CAPE CARTERET
204 W. B. McLean Drive
Cape Carteret
Swansboro. North Carolina 28584
ADJACENT RIPARIAN.,PRQgFTX OWNER STATEMENT
(FOR A PIER
I hereby certify that I own property.adjacent to
's property located at
( Name of Prop rty owner) ��j
L7-
(Lot, Block, Road, etc.
on C,ecE/<, in e4,� L��<TE2ET , N.C.
(Waterbody) ,��,� u� So u,,o ( 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 (151) 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.
------ cC� Z-----.----------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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S gnature
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Print or Type Name
_717- � 91,�
Telephone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify thatI own property adjacent to
/V,4kc'/ l� ALL Is property
Name
located at Lor 5'// A&,eTqA✓r Zk , on
( Lot, Block, Road, etc.)
0A+clg L— in C//'APE 69 k17-,E/?r T , N.C.
(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 (151) 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: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMMT)
oVE�OtD a �2Qr"C �T
J�cz.e 3i�E 'Y "VS3"- 1
h 0yvwnl�
Signature
Name
Phone Number .q�39