General Permits (542)

CERTIFICATION OF EXEMPTION
a
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 11,81111 Phone Number t ?r11
Address 05
City F a; n f State A4,P(u o Zip w .2 M
Project Location (County, State Road, Water Body, etc.) 1 f !
Type and Dimensions of Project ci r , r r &N �A !f 3' a
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-examinatiorrof the project and project site may be necessary
to continue this certification.
I SKETCH Art_,. ('C (SCALE: V/ A z ) I
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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.
Your project is subject to the North Carolina Division
of Water Quality Neuse River Buffer Rules due to its
location within the NCLISe River Basin.
Please contact Deborah Sawyer or Tom Steffens
by phone [phone] or via e-mail
Deborah Sawyer a ncmail.net or
Tom.Steffens(a memail.net.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

SUM
DIVISION OF COASTAL KtNAGEMENT
A.DJAMNT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual applying for Permit:
Address of Property: 7 ,tg'` C-ItTA
(Lot or Stret =, strut or Road, City & County)
I hereoy ccrsry that I own property adjacent to the above refe:e;,ced Prop e.L. T'ne ir:dividua
--tv,r,c for this ne=, it has described to me as shown or. the attaches drawing the deveio7menr
';.ay are proposing. A description or drawing, with d :pensions, should be provided with this
IK-* I have no oo .-c-bons to this proposes.
If you have objections to what is being proposed, please wrire the Divison of Coasral
.�fanabsment, Hes7rvn Plaza II, 151-B, Hwy. 24, Morehead Cuy, NC, 28557 or ca11 (252) 808-
2808.wirhin 10 days of receipt of this notice. No response is considered tfze same as rzo objeczorz
it you have been notified by Cerrtj ed Mail.
WAIVER SECTION
I ,derstznd that a pier, dock , moor'no piiines. break��a:e-, bcat hcuse. lip or sandbags mist ce
cack a minimum distance of 15' 5om my area of 7,pa7z, access unies_ waived by me. (Ifycu
W sih to waive the setback, you must initial the approp-ia_e blank below )
I do wish to waive the 1 5' setback: recuire--e it.
I do not wish to waive the 15' setback rec::irement.
� oa
_7 ure Date'
Print ?Name
.�.�D - / ? '2- 49 7/
Q-zhone Number With Area Code

ADJACENT RIPARIAN PROPERTY OWNER STAT -NaNT
7
I hereby certify that I own properly adjacent to Ge.sf 's
(Nam of Property Owner)
property located at
, Block, Road, etc.)
on &IE a-5E , in ��.�oc/�' , c4t*r l Co , 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 ----
i
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT I
(To be filled in by individual proposing development)
Print or Tvje Name
Telephone N. mber
Day: � N ✓D

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DIVISION OF COASTAL KtNAGEN ENT
,kDJACF-N-T RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual applying for Permit:
Address of Property:
Ar cz- ✓ Zn� /Col /K2
(Lot or strm, =, Strom' or Road, City & County)
I :eo„ cs .i v that T own prorerty adjacent to the above re:ereaced prop-.' I.Y. Tne individual
J
aoilying for this permit has described to me as shlown on the attac�,e.� drawing the deveiopme.-at
u.ey arz proposing. A desc:option or drawing, with d mensions, should be provided with thy:
le:.P.r.
Q I have no objections to this proposes.
If you have objections to what is being proposed, please write the Dtvis�on of Coastal
jtfanagemenl, Hest�vn Pla.a 17, 15,1-B, Hwy. 24, Morehead Ciry, ;VC, 28557 or call (252) 808-
2808.within 10 daysp
s of receipt of this notice. No reonse Lr considered t;ze same as no oaiecz a
it lou have been notifled by Certified Mail.
WAIN -ER SECTION
i _: derstznd that a pier, do6.- rnoorins pilings, break�a:e bcat hcuse. li= or sandbags m-,si ce
cack a minimum distance of 15' >; om my area ci r;-ar;a:, tic; ess uriess �aive3 by me. (Ifyou
X.sa to waive the setback, you must initial the approp ia.e blank be'.ow )
I do wish to waive the 1 5' setback: recuira-eat.
4', a I do not 1.107sn to waive the l�' se'_back rec.:irernent.
Date
Priint Name
i eieanone Number With Area Code
as ► 3looM„7�o�
��;1�►,�U,�, tic a Ff// 7iss

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Nam of Property Owner)
property located at
(Lot, Block, Road, etc.)
on a-56 ' E , in E.'I"Ir , C.�?641,�w Cow 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
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP..MENT
(To be fitted in by individual proposing development)
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Signature
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Print or Tvoe Name
Telephone Number
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