General Permits (813)

CERTIFICATION OF EXEMPTION s;��aq r?
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, I'
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 G LENA/ . 21 e fir✓1 C 1)0 PAL (3 Phone Number .3.31 -4 T:S:;L
Address / 4 3 AAt ISM A it0,VYX
City CAA4VkA1 State A,1r, zip 0-'9 aL/
Prect Location (County, State Road, Water Body, etc.) oj-
Type and Dimensions of Project
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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.
IP—W,%J C0007 r CAMPDX)
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.
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Applicant's signature
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CAMA Ofrcial's signature
-�A i V e AER J 0 V 0
uing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

11PY-22-2001 201.7 f3 ASTAhdDARIi COMM CORE
252 237 0019 P.03
ADJACLNT RIPARIAN PROPERTY ONNNER STAT' MN7
I hereby certify that I own property adjacmnt to -1 peg ,<, �4441I6�1 's
(?dame of Property Owner)
property ':ocat!z�3 at 110
(Lot, Block, Road, etc.)
on _Lip
(Waterbody) (Town and/or County) ,
He has described to me as shown below, the development 'he is proposing at that location,
arid, i have no obj=tions to his proposal.
DESCRUITION AND/OR DRAIAING OF PROPOSED DEVELOP.NMN'T
(To be filled in by individual propos ng development)
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Si�gnatture
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Print or Type Name
Telephone Number
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•MAY-22-2001 20:30 ASTANDARD COMM CORP
252 —2-77 0018 P.02
%DJACLNT RIP kR 1k-N PROPERTY OINNER STATE EN7
I hereby �r'df'y that I own property adjacent to � s q l„ /�i �IyY _ �'S
(Flame of Property Ow -per)
property located at �� �'�� -►9<,
(Lot, Blocks, Road, etc.)
on GJr4�i t���L�'Q --- G'�9+� N.C.
(Waterbody) (Town and/or County)
h
He has described to me as shown below, the development 'he is proposing at that location,
and, I hive no objections to his proposal.
DESCRIPTION NTD/OR DRAWLNG OF PROPOSED DEVELOP.N/MN-T
(To beJUILd in by individual proposing development)
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Signature
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Print or Type Na e
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Telephone Number �y
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