General Permits (230)

I 7
CERTIFICATION OF EXEMPTIONl
_Y FROM REQUIRING A CAMA PERMIT
-? -,a / , /
O as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commissid
e pursuant to 15 NCAC Subchapter 7K .0203.
in an area of environmental concern pur r s p
f;
Applicant Name Phone Number,_f
Address
City v State
Project Locatiori !Count State Road Water Body, etc.) --V
n Dimensions fType a dD e sio so Project
_
.y'
I
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.
I SKETCH �f / %_1_X / (SCALE: ) I
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
,da subsequent determination that a permit was required for the
evelopment.
i
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.
i
Applicant's signature 'y
CAMA Official's signature /
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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Certified Mail Receipt
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Do not use for International Mail
UHITEDSTATES (See Reverse)
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Sent to
Street & No.
S G',P1s-l117 li
P.O., State & ZIP Code
Postage
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
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to Whom & Date Delivered
Return Receipt Showing to Whom.
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7
TOTAL Postido-r
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CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Dear
This letter is to notify you as an adjacent riparian landowner of Mr/Mrs
/PYYfr✓ plans to construct
on their property located at a f S r--sue r� !-'/c
in ��,2 ��- , NC. The sketch on the reverse side accurately depicts the
proposed construction.
Should you have no objections to this proposal, please check the statement below, sign
and date the blanks below the statement, and return this letter to:
as soon as possible.
Should you have objections to this proposal, please send your written comments to the
N.C. Division of Coastal Management, P. O. Box 769, Morehead City, NC, 28557. Written
comments must be received within ten (10) days of receipt of this notice.
Failure to respond in either method within ten (10) days will be interpreted as no
objection.
Sincerely,
I have no objection to the project as presently proposed and hereby waive that
right of objection as provided in General Statute 113-229.
I have objections to the project as presently proposed and have enclosed
comments.
Signature
DATE: ( - 2 Y ' 114

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to eoti IP-z-v TxzAev 's
(Name of Property Owner)
property located at '/c�T /
(Lot, Block, Road, etc.)
on �v�j7- o'� ,�i U , in �' u-.v�'��� , N.C.
(Waterbody) (Town and/or Cou ty)
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/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
ctr C-':e fzz,
Print or Type} Name
Telephone Number
Date: (— Z (f - 1�6'

ADJACENT RIPARIAN PROPERTY OWNER STATFAIENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ///'O/t/�G �O /'Y1-?7y 's
(Name of Property Owner)
property located at 5 / t2/ d J`
(Lot, Block, Road, etc.)
on ui/9?�T © � ,�/y/ , m �1�� u .!y , N.C.
(Waterbody) (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/mooring
nilino,z/hoatlifY/h,nathnucP must be setback a minimum distance of fift--n feet /1 c'1 from my are:
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To he filled in by individual proposing development)
1d7 2
---------------------------------------- ----------------------- ----- ------------------------------------------
f2o�,01
C� C�?��fu''1 170Signature
Cd`S-AvG7�ckl fe'�evl�e- Print or Type Name
/. �%,q('vp-r p o -:;U c/o ncrl
Telephone Number
-��� Date: / _/ g ���

CERTEFIED MAIL
RETURN RECEIPT REQUESTED
Dear / - 3- -- '�' �- :
This letter is to notify you as an adjacent riparian landowner of Mr/Mrs
plans to construct /�f ��c� tG�•��
on their property located at
in (44- ��� _ , NC. The sketch on the reverse side accurately depicts the
proposed construction.
Should you have no objections to this proposal, please check the statement below, sign
and date the blanks below the statement, and return this letter to: ,Pv�vyc
as soon as possible.
Should you have objections to this proposal, please send your written comments to the
N.C. Division of Coastal Management, P. O. Box 769, Morehead City, NC, 28557. Written
comments must be received within ten (10) days of receipt of this notice.
Failure to respond in either method within ten (10) days will be interpreted as no
objection.
Sincerely,
I have no objection to the project as presently proposed and hereby waive that
right of objection as provided in General Statute 113-229.
I have objections to the project as presently proposed and have enclosed
comments.
Signature �✓
DATE: /� U

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