General Permits (2016)

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 ,"-lr..,
Address ar vi
Citv
Project Location (County, State Road, Water Body, etc.)
State
Type and Dimensions of Project _ -i r_A ccf
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.
Phone Number )S 1 -7A5 �30/
Zip 2 "
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
CAMA Official's signature
Issuing date /
s �
Expiration date
Oct. i ✓PGA,
G(/�
Attachment: 15 North Carolina Administrative Code 7K .0203

Q
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 N/CAC Subchapter 7K .0203.
Applicant Name ��'� "� r G a Pe4,- v1�/' f Phone Number
Address , c,V, .) ��. _ �'
City V ; r State Zip ;� f y 7'-�
Project Location (County St7,te Road, Water Body, etc.)
0A1, 1 f iJ el^ i/
Type and Dimensions of Project e P c:cr, - fit, - ,,� !� fie= J
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 atu
CAMA O ctal's signa ure
"_✓ ��'l it
Issuing date
V
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

4
A74.s�
RCDENK
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregsen, Director Dee Freeman, Secretary
March 24, 2011
Ann Humber
c/o Pete Sanders
PO Box 111
Smyrna, NC 28574
Dear Pete & Ann:
Attached is a Certification of Exemption. Please sign your name as indicated and return the blue
and green copies in the enclosed, self-addressed envelope.
We appreciate your early attention to this matter.
Sincerely,
y
Ryan Davenport
Coastal Management Representative
lsb
Enclosures
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www,nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper

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MAR 2 3 2011
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