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Home My WebLink AboutGilley 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 -2 UY1 i 0 e Phone Number 6 t{ 3 .214 g-7US 9 Address '' (.) Z IN,c 4 S.City L\4.1/41c_.� k ,0'2- -- State S C.: Zip a J 6(O Project Location (County,State Road, Water Body, etc.) a r\`�; J i C k.1 .�L(3un I 41 2 4 C7"00%e , L N, v t c� . 7 s 1-c_l (J C'J . V n II()-f ki ' ;,ic—r Type and Dimensions of Project Nc J -l k-1•.a. -4 P r o x . 133 , f-‘(^i vj Me-A fl I'1 k(A\4N W El -r` i I W R-4-rcl o C w e+ .p-.np S 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. SKETCH (SCALE: IVU-� Ili ) i' n i v. Y V 'r f - v ji \. \ i VI 1 _yA ac \)-Af., (11';,::..,)1 v v- ir `� V' � �' �_ �_ � �I . — ---_ -- = 4� 1 err,d� d o we i-1-s t\ff ((.) X 1 Any person who proceeds with a development without the con- (r---)r(x.� ;`� --,.xu� . x.-, sent of a CAMA official under the mistaken assumption that the Applicant's signature 1, development is exempted,will be in violation of the CAMA if there 'Tf l '--- ,i442.-iL.—Q Q is a subsequent determination that a permit was required for the • development. ( CAMA ffi ial's signature b 1 ,2UG I The applicant certifies by signing this exemption that (1)the ap- Iss ing dot plicant has read and will abide by the conditions of this exemp- tion,and(2)a written statement has been obtained from adjacent 5a�() 1 landowners certifying that they have no objections to the Expiration date proposed work. Attachment: 15 North Carolina Administrative Code 7K.0203 Locality rerInit ir'umuer GENERAL INFORMATION LAND OWNER Name 1:sG net.. G a n t) ��`1 Y1 Address 0. `Rcl( co-5- L City Lillie R t Y e i State SC zip 2.q S(L-6 Phone 0f 3--.241-76--C 1 AUTHORIZED AGENT Name -Address City State _ Zip Phone,' • __ LOCATION OF PROJECT 4124" 005c La(-) f cec/) ISIe lam. �C c4i / l L C, .7 9 4-7OL (If not oceanfront,is waterbody natural or manmade?) Cr Weft t rch ij t 4 U DESCRIPTION OF PROJECT -Ff t Vc 1e., Obkv--)e,H1 AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION (To be filled in by the Local Permit Officer prior to completing application.) Ocean Hazard Estuarine Shoreline ORW Shoreline Other PROPOSED USE //Residential Commercial/Industrial Other SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR • BUILT-UPON SURFACES (such as driveways, etc.) within 75 feet of the shoreline (575 feet of an ORW shoreline) SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING zC O SQ Fr SQUARE FOOTAGE OF SITE OTHER PERMITS MAY BE REQUIRED: Zoning, Drinking Water. Well, Septic Tank (or other sanitary waste treatment system), The activity you are planning may require Burning, Electrical, Plumbing, Heating and permits other than the CAMA minor Air Conditioning, Insulation and Energy development permit. As a service we have Conservation, FIA Certification, Sand Dune, compiled a listing of the kinds of permits that Sediment Control, Subdivision Approval, might be required. We suggest you check Mobile Home Park Approval, Highway over the list with your LPO to determine if Connection, and others. any of these apply to your project. • STATEMENT OF OWNERSHIP (, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in m AEC or a person authorized to act as an agent for purposes of applying for a CAMA minor development )ermit, certify that the person listed as landowner on this application has a significant interest in the real 7operty described therein. This interest can be described as: (check one) I an owner or record title, Title is vested inr-brU C15 W iG,I( Cc, . , see Deed Book 1473 , . L4) page(_in the Uil.SW is K County Registry of Deeds. an owner by virtue of inheritance. Applicant is an heir to the estate of probate was in County. --' if other interest;such as written contact or lease, explain below or use a separate sheet and attach to this application. r—_ n y OTIFICATION OF ADJACENT PROPERTY OWNERS _r urthermore certify that the following persons are owners of properties adjoining this property. I affirm that I ve given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for :AMA permit. (Name) (Address) ) .11- Y°'/i rt�J 166/13 ` 14- �'Uic�vas�, CIr , �. tJ <i cl r' L'7)Z C"tY.:�c? h e_ S LL} rr x,� e 41q 76 • )R DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS: cknowledge that the land owner is aware that the proposed development is planned for an area which may susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained tome the rticular hazard problems associated with this lot. This explanation was accompanied by recommendations kerning stabilization and floodproofing techniques. IRMISSION TO ENTER ON LAND irthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer :l his agents to enter on the aforementioned lands in connection with evaluating information related to this •mit application. s application includes: general information(this form),a site drawing as described on the back of this ap- :ation,the ownership statement,the AEC hazard notice where necessary,a cheek for$50.00 made payable to locality,and any information as may be provided orally by the applicant. The details of the application as :cribed by these sources are incorporated without reference in any permit which may be issued. Deviation :n these details will constitute a violation of any permit. Any person developing in an AEC without a per- is subject to civil,criminal and administrative action. s the 2.e day of „'U!v e ,20 i . n _ 1 • . l.,/ f it • Z../s i \ . `4 - CAR OVucY < z� . _ _____ i l i l 1 f co ..... POt) is __ 1. 7w3v 4 _ Mi , w t�QB F7 �\ - r ---- • • i .