General Permits (681)

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CERTIFICATION OF EXEMPTION
-� FROM
RO 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 Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
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 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 F� (SCALE: )
Ir s
Anti nnrcnn Whn nrnnccrlc with n rin\/aInnmant withmit tha mn-
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.
t 4
Applicant's signature ? G
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

10/20/98 09:20 252 726 7600 AL WILLIAMS PROP Pg. 02
w ----- ---- • -% • L%-' A A"', A A v r T 41 A"\ 01 tj JL X LVI_r_N 1
i hereby certify that I own property adjacent to , UL ti a a, s `s
Nme of Property Owner)
property located at 4 2 a '3 5 ca %" r-J D ®r .
(Lot, Block, Road, etc.)
on _ t n� ,f , in {�10 V e'r, e..a-Z
aterbody) (Town and/or Count )
He has described to me as shown below, the development he is proposing at &i at location,
and, Z knave no objections to his proposal.
DESCRIP'I'[ON A,ND/OR DRAi' ING OF PROPOSED DEVELOPMENT
(To be JWed in by individual proposing development)
0'" 61
c
Print or Type Name
q1O. q-Sq --SS i
Telephone Number
Date: ! c��

10/21/98 WED 11:40 FAX [phone] CAPITAL INV. 16002
10/29/98 15:44 252 726 7600 AL WILLIAMS PROP Ys• 62
---- -- -------- : s>_,_--:.s.:- r-,:,.a. a.x Lasrstl.e.l.dLetl.r.
I hereby certify that I own property adjacent to Pi L �N • LL % a (" s 's
(Name of Property Owner) -.
property located at 4 2 0 3 5 a%-, r" t) Zr _
(]Lot, Black, Road, etc.)
Cn g o �^�.,.. , in N v v e ;-N z-rZ , N. C.
?NVaterbody) (Town and/or Count )
He has described to me as shown below, the development he is proposing at that location,
and, r have no objections to bis proposal.
DESC: IFnON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be f Ued in by individual proposing development)
(?a"NNrj
how
tw,n
fi` ob
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Si Uature
ion Cb I/Tlrl�s
Print or Type Name
Telephone Number
Date: