General Permits (769)

r
Y CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, i , ; Jd 30 1 o t A.
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.) x ^
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.
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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 NC Division of
Water Quality Neuse River Buffer Rules due
to its location within the Neuse River Basin.
` Please contact Deborah Sawyer at
252-946-6481
,Ara,rMrh i 1
f— R
Applicant's signature
CAMA Official's signature
suina date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJAC'EA r RrAw AN PROPERTY' OWNER grATEMERr
(PM A rl&VMOO M PJjJN S(M0AliJFlYMM7110VSBj
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I hereby owtify dart I own sty 9080M to � 7C I
of ArIvaaty Oworc)
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Klock, "d, ark.)
on Eat'- . In ,�.� ��A� - . N.C.
(Wly) (Town amd/oe Coeaty)
He has described to me, as sbmm below, the denlopment he is proposing at that
locatim, and, I bays no d*cdoas fa Mg proposal. I undarsteard tSrat a piw/moorin j
p must be art back a minimum distanm of tiflea fax (15') hem my area
of riparian access unkm waived by rasa.
I &L" wash b waive do setback rsquir+emerrt.
I do wish to waive ttaat sardWA mac.
DESC.`RWMN ANWOR DRAWV4G OF PROPOSED DEVLLDPM M:
me bs jow $4 by tardtrd" propodse diawda�raeewt)
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Telephone Number
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po" ty loc ad at
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an �Jff 10 N.C.
(Wegw—` (T"M ard/er Cower)
flU leas dO =*W to met w sM a below, the iw is pagodas at diet
loos ". and, I bm ao Ows* s to his p aposn!• I undwvWd dW a pW/moorbs
pilingwUsdifMadma =u s bls at but a minimum distance o(Mkm fm t 1 S I ftm my am
of ripsem scow oofw waivrd by me.
I d„ad wiab io wal" do ssdm* r"Wn=wt.
VI do wLN to waive do ss&"* ea>golrswat.
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