General Permits (95)

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CERTIFICATION OF EXEMPTION
_Y FROM REQUIRING A CAMA PERMIT L
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
Address S 3r3r.
City Iko tc
Phone Number ?/ 9_ K 3 1� -- 4l �k
State gtzr_ zip
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 LAMA 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
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap- p Y k
plicant has read and will abide by the conditions of this exemp- Issuing date
tion, and (2) a written statement has been obtained from adjacent _ `�C,
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203

....ADJACENT RIPARIAN PROPERTY OWNER STATEMENT-'.
/Fr►u .A PIER)
I hereby certify* that •I own property adjacent to
property. r
Name
located at _ iCe 1 %� S�'-c 9
(Lot, Block, Road, etc.) ----� on
NORIT,1ors7' in AIS-z fgo3 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.
V 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 DEVELOPIUNT)
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•'•ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
• FOR •A PIER .
y y .that •I own ro ert ad acent to
X. heeb certif p P Y j
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a G n .���R. # , s property,
'Name ��, • , • - . � + : � 4 4��
fated at & Ssc % , on
(Lot, Block, Road, etc.)
'qJ in Alrb f 3- ) : CRAJAW Fp,Se N.C.
(Water Body) ., "(Tow and/or County)
has described to me as shown below the development he is
posing at that location and I have no objections to his
iposal. I understand that a pier must be set back a minimum
'-ance of fifteen feet (151) from my area of riparian access
waived by me.
I do not wish to ware that setback requirement.
Imo/ I do wish to waive that setback requirement.:o� " i,oNts w,�c
Desciiption and/or drawing of proposed development: (TO BE
�LM IN BY INDIVIDUAL PROPOSING DEVBL0P1=)
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. ADJACENT RIPARIAN P;
FOR
t,ereby certifY• that •I own property adjacent to
Da C. 's property,
Name • ;
ated at �d I 'lam ' s'' C % on
(Lot, Block, Road, etc.)
1 T C�l� in A,5.6 9ROJ �C/�. Azr,J f8/�' N.C.
(Water Body) '(Tow and/or County)
has described to me as shown below the development he is
',posing at that location and I have no objections to his
)posal. I understand that a pier must be set back a Minimum
>tance of f if teen feet (151) f rom my area of riparian access
Less waived by me
1 I do not wish to waive that setback requirement.
I do wish to waive that setback requirement. � Ro—lo�,"-, w„A,
Description and/or drawing of proposed development: (TO BE
LLED IN BY INDIVIDUAL PROPOSING DEVELOPI=)
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