General Permits (70)

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CERTIFICATION OF EXEMPTION 9/jo-
FROM REQUIRING A CAMA PERMIT pA r�°�
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 ('x" -S_ // e<;ed J,_Phone Number a 9 2 9 v V
Address ROY A.2 /
City 6 0 State Aje Zip ' s -
Project Location (County, State Road, Water Body, etc.) 3,. -7fp ; iiii ;2cc 26
Type and Dimensions of Project t'i f� r ��.. �� `,ire ' ,: �.�- .� iD At a V ' "1 " s ti"Jf d
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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.zezamination of the project and project site may be necessary
to continue this certification.
SKETCH t4er_ /y7,4 (SCALE: )
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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.
l yllv' � 1 1A /.!":s
Applicant ss'sig ure
CAMA Official's sfgnature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

INKING FURN. TEL NQ.919-441-6444
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Apr 22,96 11:51 P.O2
( h PIE ,
I hereby ce tit that I own. property.adjanent to
(L.l. 's property located et
Hawoe a -property 3 , PAJ
ME, etc.
Uri iri N.G.
a r —TT—Own Mwor ouuty!
He ;has described to met its shown below, the developmarit he is
propcoing at that location, and, I have no objectLons to his
proposal. I understand that a pier must be bet }sack a Minimum
distance of Elf teon feet (151) from my area- of riparian acceas
un2.ea-a ived by inb.
� S do not wish to waive that setback requirement.
I �o wish to waive that setback raquirement6
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Print or 'ipe Name
Telep ona Number
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04/22/96 1.2:02 TX/RX N0.3601 P.002

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby c rti y that I own property.adjacent to
's property located at
(Name of Prope y er)
(Lot, Block, Road, etc.)
on in �eC�+'�%� ltas�l�e21 , N. C .
Waterbody)• (Town and/ r 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.
do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
( Toy be f i l? ed ir_ by individual proposing development)
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-K a � Z -1/ M C %- 740
Priny or Type Name
3(037
elephone Number