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HomeMy WebLinkAboutGeneral Permits (804)7 IMP �. 7 (,- � nCERTIFICATION OF EXEMPTION _Y_ 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 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 (SCALE: ) Vr V 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. Applicant's signature CAMA Official's signature Issuing date Expiration date Attachment: 15 North Carolina Administrative Code 7K .0203 ` ' r ' � � - ` ------'------ -------' +~ ` � / ^�^ ---------------'------'� �~ ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to A . /)nJ (Name of Property Own(er) property located at//? H 4�jk„-* L rj (10 Af bEEe- L (Lott, Block, Road, etc.) on ;�� ll J S C�E k , in CfJ S// d 3" , 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 (To be filled in by individual proposing development) A 16 Y\,� ple . 6 lot- IJP�kr-Pz A-7' O'Hz!�Q� Signature JV II r A,tv�4OR C,, H O` f E k Print or Type Name Telephone Number Date: I L) Z- i o) D aD ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to , {�. Alk(i —4�E #y 2 1 /looet's (Name of Property Owner) property located at f 7 1 A*'t;1' C'e6 �� �✓ ���� �sl .J (Lot, Block, Road, etc.) on Cic£�K , in (0S a (IJ 0ockn , 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 (To be filled in by individual proposing development) ­1 ,eP'i"ri '� -a f--f-a C-kF- '�, MI Signature Print or Type Name (ql 6) 3a t-0` �'� I Telephone Number Date: 2 ,-- -Y 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 �� oc' 4_` Phone Number Address ' City v State Cam{ Zip C Project Locatloq (County, State Ro;V, Water gody,,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. S SKETCy (SCALE: V( E/"/ l (PI"�l - 'k, -�c 1� �_WL's L _�\ Va(_'C 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. icant's signa ure 1A Official's sl nature C ng date • �/ Expiration date i' / Attachment: 15 Nlortti Carolina Administrative Code 7K .0203 -4c- �w