General Permits (841)

O
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 � '�J+ ►� ; r.ntn5y AC.rf i `;10 t� �Ai�c7f Phone Number f 710- 24- 75_5?
Address
City State Zip / ..Jib f
Project Location (County, State Road, Water Body, etc.) 77�—)
Type and Dimensions of Project -7 ' r , Py41
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.
SKETCH
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.
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.
d > r 00
(SCALE:jf
FCA
r'r' • ' 1�T A 3!
"pplican4's signature
1
CAMA Official's signature
i•
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

I hereby certify that I own property adjacent to
property located at
4" fillev Narre
(Lot,
i t nn aeker Is
(Name of Propertwner)
Road, etc.)
on Brown Creek , in mft V - &Muo e
N.C.
(Waterbody) (Town and/or Cotnty)
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)
13YoWr
W.tytrhawse e
Signature
Print or Type Name
Telephone Number
Date: IT_ _�� d /

E'r'Er'Hi E:USEP - - - F'HGE Cif
{ i7trrebu certify that I own prUI7trly adjacent to �ylcl 'Penny
r' 's
_ -
(;Marne Of Property Owner)
prciperfy kx-,aatt Y ; Nurovis
.-------.fi ot, {+It:k-, Jitrad, etc..) _--------
7
(Water -body) ('I'OU'►l and/or oUflty)
He has described to me as shown beiOW, cree clevi�Iuprr,ew he is proposing at that location,
;;o cgections to his pr-oposal.
DESCRMION AN-D/OR. DR.A.W N'�`t:, OF l' Rt3p oSED DEV ELUVIVXEN,I-
(To be fided in by indi�'idu:al propus-ing development)
era
���'; �� +�� �+t���',.�V.� �,r.°, �e+�c�'r' pr►fit
rype- Name
Number - -
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