General Permits (860)

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
Address
City -
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.
State
Phone Number 7 , :� -_T_1 5 / J
Zip {
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: ) I
71i
- r nar ie�r�siaie�s CIO
d
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.
Appucant's signature t
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ent BY: OOTOR FLOORING; 9193823310; Jan-31-01 16:47; Palle 6/8
1-723 P.Q02AC? F-098
-24-a1 01:52p� Fcnm-
ADJACENT RIPARi AN NtOPERTY OWNER STATEMENT
! hereby certify that 1 own plop rh+
ad'acwt tO ?O-LLI'S ] OC'rO F2 , -- "3
(Nerve of Property Owner)
Arty locates at A�a�.�-zrt-c-�� _—
(L-Ot, 61vGk, Road, eic-)
on ,lit. t]
(Waterlx�ciy) (flown arld/or County)
EE-Q o i 200l
He has dVacritred to me as shown below. the development he is proposing at that [auation,
ar4, 4 have MQ abjecbOns to his pr4pa.z
Vl A U- --
t
DESCRIPTION AND/OR DRAWING OF PROPOSED DEY5LOPMEHT
(To be fiWd in by ineviduei prOPOSIng dev0bPrrr&rW
-
-11a
Qa�o,ar+aG�
W ALL �
� a•5' � •kSi �
�a ie.`�l• DTI �5�, �C�IL
t� �• f►Dt+ fi�P�QRP ul�7t+,e1
410'
� a
Mrw WoKw. L.i,4e Signature
Print or Type Name
C\`0,-fig\
relept;' & Numtwr
Date. \ r- .�$ - 0 ._..._

7bnt By: PROCTOR FLOORING; 9193823310; Jan-31-01 16:38; Page 3/3
A' �
ADJACENT RIPARIAN PROPERTY OWNER STATEMO r
l hereb certify that I own property adjacent to �N-�LLI 5 �;CcrcFz, 5
Y fY p P —
(Name of Properly Owner)
property located at�O"j"-i
(Lot, Block, Road, etc.)
on � L2 �.iD in i ' oREt4fjgt> C1tT N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that,ocation,
and, I have no objections to his proposa 11
g'os&i7 FbJDP� f�! +J r �1 c, U3 AA.A-- —
DESCRIPTION ANDJOR DRAWING OF PROPOSED DEVELOPME14T
(To be filled in by individual proposing development)
� Qrlolo5&D
�ipSuNrtJG, �+
WALL
4V AA6.t.tS. t
�o
En6C 10 5%ryrr11a 01 A 6
qo'
45' L..J,,o6
t2tfrr�� at ►� ul r►u., -rb
kAiA ENAffiR. Er�ae
fc.ktS7;tJG Roc.K.
5,`7n
F)�)"N�
� k
Signature
Gene : E� (V
Confirming our conversation, we afire T Name
to pay $750.00 for 10 feet of your seaqNp1 ype
where it Connects in the corner with ours,
1p�-and, in turn, you agree to allow us to rework
0 the existing riprap and add new at of
and within CAMA guidelines which is a eig ne umber
base of our East wall but on your property. r
c
,��'o Date:

A ­1
PERM=E
LOCATION:
MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
r
' S NAME. S PERMIT #
FIELD REP.
PHONE: �� ?j—�S L DATE REPORTEDLY COMPLETE: O l
1) Do the ured dimensions of the development differ from those indicated in the permit and workplat?
YES O ircle one].
COMMENT:
2) SEDIMENTATION ROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized
all disturbed areas?�".O [circle one]
COMMENT:
3) FUTURE MONITORING & ENFORCEMENT ACTION: Is further investigation or enforcement
action needed? YES/ O [circle one].
COMMENT: