General Permits (208)

Applicant Name
Address51
City e !. �
Project Locatior
CERTIFICATION OF EXEM .l S, h C
FROM REQUIRING A CAMA PERMIT MAC 1 1
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the C
in an area of environmental concern pursuant to 15 NCAC Subchapter�,,������
f ,'c r .r /E, Phone Number r eeiZln 3Y/- 47,/-�
State Road, Water Body, etc.)
—. I /1
Type and Dimensions of Project
State A,� Zip �2 79vq
fl" r...-I 'AL
The proposed project to be located and constructed as described Thi�rtitieation-of_exemption from requiring a CAMA permit is
above is hereby certified as exempt from the LAMA permit re va'frd for 90 days fror�the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a rA-iwnmatioi pe project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this ce ification.
your obtaining any other"'State, Federal, or Local authorization.
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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.
'Applicant's skhature J '
CAMA Official's sigr(ature
Issuing date
xpiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

State of North Carolina
Department of Environment,
Health and Natural Resources AIF.N-;TA
Division of Coastal Management
James B. Hunt, Jr., Governor p E H N
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
March 11, 1996
Mr. William J. Parker, Jr.
305 Pineview Dr.
Elizabeth City, NC 27907
Dear Mr. Parker:
Attached is a Certification of Exemption authorizing the construction of a 75' pier with
a 10' X 20' "T" shaped platform and the installation of one mooring piling on Ganny Gut,
adjacent your property located off SR 1307, in Dawson Bluff near Arapahoe, in Pamlico
County.
In order to validate this exemption, please sign all three (3) copies as indicated. Retain
the yellow copy for your files and return the green and blue signed copies to us in the enclosed,
self-addressed envelope. If you have any questions, please don't hesitate to contact me at (919)
726-7021.
Sincerely,
M. Ted Tyndall
Field Representative
MTT
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #11-12-09
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 500k recycled/ 1096 post -consumer paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to titil/,mj l-/`1st PlwKr-rl-
property located at Lt7-'/
(lot, block, road, etc)
on C'eak - / Cyu% in It21M /V-C
(body of ater) (town)
North Carolina in P1?1i1L,ey County. The proposal has been described to
me as shown below; the development, a pier/bulkhead/structure, and the
(circle one)
proposed location, and I have not objection to the proposal. I under-
stand that if the development is a pier, it must be set back a minimum
dista f 15 feet from my area of riparian access unless waived by me.
I do do no wish to waive that setback requirement.
(cie)
Description and/or drawing of proposed development: (to be filled in by
individual proposing development). INDICATE THE SIZE AND LOCATION OF THE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND THE WATER.
567 Ar-mcivco DE 5cRip"'7t'k,'
(Original must be retained in the Inspection Department)
Q��
Signature
�ECEIVEO
. - C 2 7 1995
i d - I N -�I-
Date
game (Please Print) l` r
x
15-awe
�6 f �e

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L(,1y,//iNn-1 J, ILis,d
property located at 4O7
(lot, block, road, etc)
on 6�4,A-'A- y/ 64,7- in
( ody of water) (town)
North Carolina in �Av�t,._ County. The proposal has been described to
me as shown below; the development, a pier/bulkhead/structure, and the
(circle one)
proposed location, and I have not objection to the proposal. I under-
stand that if the development is a pier, it must be set back a minimum
distance of 15 feet from my area of riparian access unless waived by me.
I do o notJ wish to waive that setback requirement.
(circle one)
Description and/or drawing of proposed development: (to be filled in by
individual proposing development). INDICATE THE SIZE AND LOCATION OF THE
STRUCTURE AND THE DISTANCE BETWEEN EACH PROPERTY LINE AND THE WATER.
(Original must be retained in the Inspection Department)
Signature
Date
Name (Please Pint
SEC