General Permits (904)

-� CERTIFICATION OF EXEMPTION r
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, G I'd u32 l i t� ed(
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.
0) 336-M,66& 9
Applicant Name �:� M(i A : ro . i L Phone Number ' Q 7.V r/V 7 • ��89
Address 7 mf n(1:4 r-
City ,i r' State /V,' Zip 2 a 31 o
Project Location (County, State Road, Water Body, etc.) tf- �r f r ,: 4, A4 L 7 S .F,...• 4 rt.. awl
Type and Dimensions of Project " Per C 4c�, +�, IVS,4( -fv, 1 K44
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.
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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.
Appacanrs signature t
CAMA Official's signature
Issuing date
'.
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

SENT BY: CORNERSTONE PSYCHOLOGICAL SERVIC;336 854 7784; FED-27-01 11:10AM; PAGE 212
Feb 27 01 10;05a M a H Body Shop [phone] p.2
ADJACENT RIPARIAN PROPERTY OWNED STAT EVMNT
I hereby certify that I own property adjacent toy,-� ,s
'N of operty Owner)
Property located at 6---------------
(Lot, Block, Road, etc.)
on / � in C .: 1Pv ec . Cie .
(Waterbody) (, N.C.
Town and/or County)
He has described to me as shown below, the development he is proposing at that Iocatior,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOIPNIIENT
(Tv he flUed in by indiv&,W proposing deveFnpmenl)
Signature c
15ea'-7h /7
Print or Type Name
TeIcphone NGmber
Darr: 3 /,q - G /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
e (olProperty Owner)
property located at
(Lot, Block, Road, etc.)
ZI on < ,X tS1c,-c in 6-ersa-)-���� , N. C.
(W�terbody) (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)
Signature
Print or Type Name
J-5�4 — 'I z-i- '�: _ 2' 7 `2
Telephone Number
Date: 3 / 4