General Permits (963)

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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 Jwjk► -i M sWri t1 A mobs Phone Number -4t;+ 332- _ j 15
Address 030 Ourc/us Vl'
City 'iai!?4 >y State NC Zip Zf,,` o i-
Project Location (County, State Road, Water Body, etc.) •,AfAl NLf "''t r,
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Type and Dimensions of Project RiP RAP f-11 1001p
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.
Applicant's signature
's�C i f �'4Atar4
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PERMI'ITEE' S NAME:
11A M
In/o'dJ
PERMIT#
LOCATION: kQ+ "
Wat"
K } ��t r c 7 s� �rP. C�{�� 24 h hrAi h
FIELD REP. 1�a v{--
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PHONE: 7oY-3712 - 30S"
DATE REPORTEDLY COMPLETE: g - 2/ - D /
1) Do the measured dimensions of the development differ from those indicated in the permit and workplat?
YES/T�qircle one].
COMMENT:
2) SEDIMENTATION &=OSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized
all disturbed areas? V
/NO [circle one]
COMMENT:
3) FUTURE MONITQRM& ENFORCEMENT ACTION: Is further investigation or enforcement
action needed? YES/ O circle one].
COMMENT:

ADJACENT RIPARIAN PROPERTY OWNER STATE'i TENT
I hereby c;stify that I own property adjacent to K4 4- -' / �) �a� �!J 's
(Name of Property Owner)
property located at q L n> u i �Z 1}FA �� d Iy l 1 0 "J
(Lot, Block, Road, etc.)
on W4 t� O �t K eve.,— in
. 'e re (� u �j fi N.C.
(Waterbody) (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 he jgUed in by individual proposing development)
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Signature
Q /11, how
Print or Type Name
Telephone Number
Date: /eq 2 — �'

_kDJACLNT REPARL�N PROPERTY OW-N-ER STATE�M\T
? f e-eby ct LIfy that I own prop- Ly adjacent to �9 1-f &f -4 104 Iz-M 'q �y � �C� I s
(Name of Property Owner)
props, y located at (U t �.! r.i , P � �p C"— 5 u, b c1 ! V i 5 1,3 4)
(Lot, Block, Road, etc.)
on,in C° reu i N.C.
(Waterbody) (Torn and/or County)
F- has described to me as shown below, the development 'he is proposing at that location,
and, I save no objections to his proposal.
DESCRIPTION AND/OR DRtiiTL�G OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
/4
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Sig a re
6azow
Print or Type Name
(,2mw) 13q�-� �-
Telephone Number

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