General Permits (852)

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CERTIF:ICATI.ON, OF EXEMPTION-
_Y FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,�T jZ ti 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. ,
J Phone Number :' 6i .'i-71 11�, {
Applicant Name j !� �-
Address th Ci,
City State Zip ^ " S ► 2
Project Location (County, State Road, Water Body, etc.) E E
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 issuanee.,Fbllbwing-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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
P,
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hCrcby certify that 1 own property adiaccnt to Owner)
(Name of PrWc y
rHe6 OAk
P7O y locatcd at (Lot, Block, Road, etc.)
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on _ Pf NE tiN�� ! G(��.SE� t%�'�� (Town and/or County)
(Waterbody)
He has described to me ,_a shown below, the dcvcloprn ent he is prvposlnJZ at that location
uW, iAuve no objections to his PrOPOW-
G OF PROPOSED DEVELOPr .
DESCRwrION AND/ DRAWING drwlop�1
!To be rdkd ims ky Individual p�Po
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ADJACENT RLPARIAN PROPERTY OWNER STATkUV EN"1'
p • �AS:ttJ 's
rt adj+ccnt to R APc
I hGrcby c;crtify that 1 own props y (Name Of p"pcly Uvrncr)
If �Kas vA�
propcity loci at (Lot, Block, Road. Ctc.)
N.C.
on rvE Aoo ' u,,kTE �'owo.d/oc Caunty)
(Waierbody) � at that locati��
to cnc as �� mow, the dcvdopmcat he is W°p°s'°
He has dcs� ibcd
", t lWve no *W't'0 is to his pmpos&l•
WING OF PROPOSE DEYF-OPr
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