General Permits (8215)

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 `r.,J f 1 k- I: � N 1
Address ;(J-7 ';,-L
City - P,7rt:
Project Location (County, State Road, Water Body, etc.)
-
Phone Number '2SF_Z4A i i-tor
State Zip 2
�IJt,J
Type and Dimensions of Project tt�ti�t
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
Oa subsequent determination that a permit was required for the
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.
Applicant's signature +
CAMA official's signature
I � �— _ '- . <rJU
Issuing date
A
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 9j-1t, o i is
(Name of Property Owner)
property located at 4 / /,t i Tc yi j(
(Lot, Block, Road, etc.)
on f�rvSr lt�/yr'vt , in jlitiI/cCl) , N.C.
(Waterbody) (Town and/or Coin)
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 da wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
I� 06K
c/5 C- X71 tlr'4
z
7•1�ltiyc�`'%/t
Print or Type Name
2.52.�2-4- -1 b
Telephone Number
Date: 211 ib 1 2o0v
Tom'

UNC TELECOM. Fax:[phone] Feb 16 '00 12:50 F.f21
02-15-90 12:47 GAIL/LOFT REALTY ID�2522492930 P.02
"JACE MPARZLN PROPERTY OWNER STAMY=
(FORA FIE MOMNO PIUNGSIBOA7YJFTIBOATHOUSE)
I horcby certify ti'tat X own property 4acent to
(Naive of Property O wuec)
_ Py incmw at
(Lot, Btoek, Road, etc')
onytc�l t,�t , i„>t G o C a . ' y �, N.C.
(VVAtecbody) (Town and/or Caunty) .
He has described t0i tle, as Shown below, the dcyclopment he is Ptuposing at that lot�tion,
ud, I have no of j(tdficoms t0 his VMPO..."I.. I .understand that a pierlmooring
Pill slboe ft/bc ►otasc.z1.tusi be sct back a' minim*
um of fifteen feet (15 ') from my area
of riparian $cress uriYcss ,,rivCd by rise.
r ao not wish to waive the setback rcqu(rement
I da wish 'a0 l vive that: setback requirement.
WSCRUMON Al l"01OR ;DRAWING OF PROPOSED DEVELOPMENT:
(To beflUed k by indivutuai proposing development)
p�p��i60 rlJ�lYl�r
r7a '. Jr /d
02-16-00 13:41
Sl��ture
��r 1
Print or Type Name -
L-1 —7'!
Telephone Member
RECEIVED FROM:919 962 1102
P•02