General Permits (437)

i�
CERTIFICATION OF EXEMPTION Co
FROM REQUIRING A CAMA PERMIT! T p�
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Com sion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Sd'rr� r ter-, Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.) F r
Type and Dimensions of Project
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 g0 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMA Official's signature -
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

GRAFTON MARINE CONST\SUCTION
105 SEA HORSE DRIVE
SWANSBORO, NORTH CAROLINA 28584
919-393-6137
ADJACENT -RIPARIAN PROPERTY OWNER STATEMENT
(Lot, Block, Road, Etc.)
m
(Water Body)
in
0
, North Carolina.
(Town and/or County) '
Property owner has described to me the proposed development
as shown in drawing.
I obiect to oroosoed Droiect.
(DO) (Do Not)
I understand that a pier must be set back a minimum distance
of fifteen (15) feet from my area of riparian access unless waived
by me.
I � , wish to waive the setback requirement.
(Do) (Do Not)
DESCRIPTION OF DRAWING (Must be filled in)
Deck over Lift
Roof over Lift
Boat Lift
Pi er
Pole Replacement
b -
Signature
CF14[2LLS L, r"}L�/Sow S(7
-
Name (Print)
71-17 s` 3.5-
Phone Number
Apr"

GRAFTON MARINE CONSTRUCTION
105 SEA HORSE DRIVE
SWANSBORO, NORTH CAROLINA 28584
919-393-6137
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
� � 9 �'s property located at
--
(Lot, Block, Road, Etc.)
on Pe hlij:4�
(Water Body)
in 1J�� 13, North Carolina.
(Town and/or County)
Property owner has described to me the proposed development
as shown in drawing.
I object to propooed project.
(Do) (Do Not)
I understand that a pier must be set back a minimum distance
of fifteen (1511 feet from my area of riparian access unless waived
by me.
(Do)
(Do Not)
wish to waive the setback requirement.
DESCRIPTION OF DRAWING (Must be filled in)
Deck over Lift
Roof over Lift
Boat Lift
Pier
Pole Replacement
".,I,(
XZ�Si na r�
r' �(C"e'zl�
vpf L�P1'4l��l) �� 2
APhone Number
AOWM�--

} 11• \
'. agj.♦
., r

�.-l� -� 3
So-L,-
�� �� �� ��
�/�Q r
i��3y