General Permits (67)

9
-� CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT ��IV" da c Soar• v�' lam,
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commissioc 1P
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name
Address 13
City,
Proiect Locatior
Phone Number --J /U - �--? -2,1
r, f Lo State f Zip > 6
^ni mfii State Road Water Pod etc ) r..c. i -7 , . 1 .-> .. - � _ l � 'z f)rr t , i
> Y�
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.
I SKETCH P'j- A. (SCALE: ) I
n6�F' 1
Li
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.
10
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Appup nrs si nature
lU,
CAMA Official's signature
y_lo-y
Issuing date
7-lG ~9f
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

Name of Individual Applying For Kermit: !' RR &S L. 6;41z&— �-
Address of Proportys tors /Sd- lI — 13o V- /-?;k Dol"�s;oe dP
(Loz or Street #, Street or Road, City & Country)
t hr2rcby certify that I ourn property adjacent to the above-
reterot;(;ed pt-uperty. The individual applying for this permit has
to the as shown on t1je attached drawing the development
thfly are proposing. A descript Lan car dc'awiny, with dimensions,
E;h1JU11d tJe pc-'.)vic3ed with this letter.
1/ I have no objections to this proposal.
IL you-liave objections to what is_being c)z-oi)cseaL please write the
Divi::,ion o- Coastal.__Hla_na.c 127 Card. nal Drive Ea(t PIlS1C`Tl,
WP LinLnrtton. North Ca.ro-ina, 2R405 or Call-91J 395-�00 wit•trin 1.0
dav� of ro�•e. 1t nE._ti i,5 not-.i^.A. No resoon�c, considered 1N same
__- t}
,v� nu objection it you have- been notifiAcl..i).y Certified Mail
WAIVER SECTION
I nd that a p _r, dock, 1llUol'lI p9i ; inas, bZK"
z. _r, boat
);U.l:�f:1 lift or ors must bu ;et: bacK a i mum �.nce of 15'
frurt my ar rip��ria ccess unless waived by m If you wish
to wa the setback, you 40 st initial Un appropria blank
bel
— I do wish to waive the 151setback requirement.
�I do not: wish to waive the 151setback requirement,
X11G
1 natu e Date
1 s
Pt vi -Name � ��..�.
E F=
Telephone Number With Area Code
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I1T" TABLE
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LEGEND
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. Namcl of Individual Applying For hermit: L&S
Address Of Property: ,.a rS /.5-4- /6 — l30 ,t /3 z e )x
(Lot or Street #, Street or Road, City & County)
r tinrcny certify that I own property adjacent to the above-
reter�I;C;t?d pt-uperty. The individual applying for this pe_mit has
to me as shown on the attachel drawing the development
thFiy are proposing. A description or drawiny, with dimensions,
.,loin(( bra pc-uvided With this letter,
have no objections this ro .
7 o F Pos�l
i _yuu_i;tZ'�q_ o'tlections to wha_, is beinu UrUUOsed lease 4rite the
0,tvi;,,ion of Coastal . ManagPmgn_t , 127 Cardinal Drive extension,
Slilmi�c;ton. North c,,a.rc�lin�, 22405 or call_91J 39r-3900 within 1.0
yof rc�•e_ot:.r?_E._thts not'.ice. No .resoon.�c is CQ'isia+�Leil t1iN SZme �
tic)_obiection if ycu have been notifited._b.y Certitied Me tl
WAIVER SECTION
I nd that a<p,", dock, mcorirl pi'Linas, breakw3a -r, boati'or must be set tacKa _ um dis nce of 15'
[rum my ar ripaccess unless waived by m Tf you wish
tc� �a the setback, you _- st initial t. a,ppropris blank
bel �. )
_ I do wish to waive the 151setback requirement.
�f do not wish to waive the 15'setback requirement,
na Qure Dace + a
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P r L t� tr N t. t o �,...r.r►� �iw
Telephone Number With Area Code
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