General Permits (541)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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 Ohv r r J i W:i Phone Number <Sa ¢3� 11 V
Address i 3 Cal, 1� v , r
City i%i State Zip J 5^
Project Location (County, State Road, Water Body, etc.) u, fr 15'
Type and Dimensions of Project -T "� .� ram^ n i % 1- 0 /tlk L .
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-examination of the project and project site may be necessary
to continue this certification.
SKETCH i+('6 - (5 (SCALE: f. ^- )
Your project is subject to the North Carolina Division
N�`'{< 1 / ti+ k r"'ti^r�r' as b+ fk GeC'=•r„"� of Water Quality Neuse River Buffer Rules due to its
1 location within the Neuse River Basin.
tL ` ti,' i !-d A leis-., Please contact Deborah Sawyer or Tom Steffens
kit R r cN (a r/ l9 E if Q l by phone [phone] or via e-mail
Deborah.Sawyen-oncmail.net or
(/1tr4{i File Tom.Sterrensamcmail.net.
n _.... ..L... .. ..A .., M, , A,,,-Innmo nt withn+it tho rnn-
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.
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Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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DIVISION OF COASTAL NL-�NAGEMENT
ADJACENT RIPARIAN PROPERTY OW:NT-R tiOTIFICATIO—N/WAIVER FORM
Name of Individual applying for Permit: —SF 2— S /- - , e
".ddress of Property:
(Lot or Street =, Sam.: or Road, City & County)
I hereby cer-sry that I own property adjacent to the a:,ove rere:enced propery. The individual
aooiying for this permit has described to me as shown on the attache^ dr^awina the dove?opmenc
r.
:ey are proposing. A descrrIption or drawing, with e :nensions, should be provided with this
I have no objections to this proposL".
If you have objections to what is being proposed, please wrire the Division of Coastal
.�fanaoement, Hestron Plan Il, 151-B, Hwv. 24, Morehzad City, TC, 28557 or call (252) 808-
2308 within 10 days of receipt of this notice. No resporzs6 is considered the same as no obiecdon
if you have been notified by Certified Mail
WAF'v-ER SECTION
I _:,derstznd that a pier, dock-., mooring pilings, break xa:-�", boat house, li;C or sandbags must be
back: a minimum distance of I 5' ii om my area of
r, access uniess vt aived by me. (I you
to v.-aive the setback, you must initial the approp:,a:: :)iank below.)
I do wish to waive the 15' setback rec�i-�-ent.
I do not wish to waive the IS' setback; red :irement.
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rant wame
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T-ziechone Number With Area Code

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ,iy��s L-. C"-T ' 's
(Name of Property Owner)
property located at
(Lot, Block; Road, etc.)
on %P�c Se /1"� LPi✓ K-�/� ZA eL,& , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
by individual proposing development)
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ianature
Print or Type Name
( >- ) tlz— 6)
Now
Telephond Number q
Date:

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�37- 9i7/

}6/2002
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08:28 2526371934
3 `"•p - 3 1VIC 74oS
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DOT AND JIM FUSS
PAGE 02
DIVISION OF COASTAL NLkNAGEMENT
ADJACENT RIPARIAN PROPERTY OWE -ER `iOTIFICATIONIWAIVER FOF-Nl
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Name of Individual applying for Permit:- _ - L `
.ddress of Property:
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(Lot or Strut �t' �' or Road, City &County)
I here*oy cet�fy that I own property adjacent to the a.,ove reverenced prope.;y. The individual
aoofying for this permit has descrioed to me as shown on the attached drawing the de �c:opment
are proposing. A description or drawing, with C:.,iens;ons, snouid be provided w,th this
1c::er.
I have no o'oiections to this pr000sL-
hat is being proposed, please wrue the Division of Coastal
Ir" you have objections to w
tf2rta,sment, Henrnrz P1a�a II, Lit-8, Hwy. 2, Morz2z d Cirv, ,�'C, ?8»7 or call (��?) 808-
�808 w thin 10 days of receipt of this notice. No resoorts� :s considered the same as rto ooiection
ir^ you have been notijted by Cerrif ed Mail.
W.kr'TR SECTIC`
[ ders:anC that a pier, dock, moor,ng pHinQs, brec`.�z:_- boat house li;, Or 53r1�b2c; n L�
- access uniess �2.1ved by me. (: 'YOB:
'; aci: a minimum distance or 1 5' mom my area of rr;: -
to Waive the se_back you must initial the aooroe-a:: b+ani: be!o-�- )
/ I do wish to waive the 1 5' se:back
S: q� ax-ura
I do not wish to waive the 15; setback re_' irz-Went
Date
P-,,m Nan-141
T�;e:)hone Number With Area Cade
rnAR-06-2002 07:47 2526371934 98%
P.02

b/2002
08:28 2526371934 DOT AND JIM FUSS PAGE 03
ADJACENT RIPARMN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
located at
(Lot, Block, Road, etc.)
0
n in _ ! ✓�.t/C�✓ / ��,e , N, C _
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
I.- �n�,� c„ by 1 dIVnl proposing development)
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Si'natu
tint or `f pe Name
Telephone Number
i
Date- J?
MAR-06-2002 07:47 2526371934 98i P.03

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