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CERTIFICATION OF EXEMPTIOW�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. j
Applicant Names Phone Number 7 3
Address ! 4. t k 3 +
City State c Zip 77 5t�
Project Location (County, State Road, Water Body, etc.) 'rAvra (c- A . t f
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ii�� Ai�,yr,- �;t1(nNDS 1to'rSi
Type and Dimensions of Project t n
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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.
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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.
A& I ida nt's s ig n at u re
CAMA Official's signature
Issuing date
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Expiration date
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Attachment: 15 North Carolina Administrative Code 7K .0203
FROM : LIOE OAK DEUELOPMENT COMPANY PHONE NO. : 919 633 6027 Oct. 16 2000 12:35PM P2
AUJACEME 1tl.PAI IAN 1'1t01'L1U)( U WNLlt 5 t r :11 J1II 1 ,1 1
fcr � s
111creby cerdry (fiat I own (nopc V adjaccnt to C G
f(N�u„c ur rri,t,crty Cl►vnca-)
prvperty 'mated at Sa v<' (Lit, 13lock, li.uad, etc.)
P(,5 i�tUc'�2- , i11
U e
Qu
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(Wgterllody) '1'owu mud/or Cuulity)
XIe llas described to me as sfwwn below, Ole develosulcilt lie -is l)I- t1 ilig at nit lucatiou,
L�
at1d, I hAVC no objcctiotts to ids prulx>sal.
`---------
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DISC1tI1''.C10N ANDIOIt DRAWING OF PltopOSEI) DEVELOP(VIENT
("d'o be fjlded in by Individual proposing develvflrnealj
,...., , ou Pay A�
'ZB
e ,
t^ 3'*-
C .
quip commends gllvuld be made to
'red TY11dull, ""N'i20dUiel,e�d
City, NC
-- _ ----
Signature
Print or Type Namo
CT.
Telephone Number
Date: L___
0
■ Complete items 1, 2, and 3. Also complete
A. Received by (Please Print Clearly)
H.
Date of Delivery
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
C. Signature
X
❑ Agent
❑ Addressee
D. Is delivery address different from item 'f?
If YES, enter delivery address below:
❑Yes
❑ No
1. Article Addressed to:
w A y
(U"U /�
3. Service Type
Z / U S
`❑' "Certified Mail ❑ Express Mail
❑ Registered M-Return Receipt for Merchandise
2. Article Number (Copy from service labe4—
PS Form 3811, July 1999
4. Restricted Delivery? (Extra Fee) ❑ Yes
p � 9'/e0'1�e)// '-'-as-')
Domestic Return Receipt 102595-00-M-0952
ADJAC 1' ItIPAlUAN I'1tOPEK1'Y OWNLIt S'1'A'1' AIEN'1'
I hereby certify that I own property adjacent to 26J74 13 DC D,AJ
(Naine of I'rolmdly Owner)
property located at /`) A.) ,
(Lot, Block, Road, etc.)
on &eItli"If— 10-iin � �vP�L �-C> , 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.
DFSCIWYfION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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�z6,<--=� iOc� � j
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Any comments should be made to
Ted Tyndell, DEIINR Morehead
City, NC qTq 800 2808
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---------------------------------------------------------
S' na ure
Print or Type Name
Telephone Number
Date: 11 o -e"'O.
.3-I 33) 5; d_3
ADJACENT RII'ARIAN PitOPEItTY OWNE It STATE NIENT
I hereby certify that I own property adjacent to Xy r.J'' ` ' t 's
(Name of Properly Owner)
property located at U'/` Y j- _ 7/-,,-1 �1'
(Lot, Block, Road, etc.)
on /t% i'G� .t `�� ��� , in �'/1 f� r� Y�. �� , N.C.
(Waterbody) (Town andlor County)
He has described to me as shown below, the development lie is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
G- & /
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Any comments should be made to
Ted Tyndell, DEHNR Morehead
City, NC %' 808 2808
�f-
Signature
—
Print or Type Name
Telephone Number
Date:
L?
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