General Permits (2361)

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 Coasta R sources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K.-0203:-.
Applicant Name r
Address y
City /•:
Project Location (County, State Road, Water Body, etc_)
Type and Dime n ions of Project o v I cam,
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.-fhis exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal„or Local authorization.
SKETCH
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.
Phone Number
ry
State Zip
"+ 26
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.
(SCALE:
Applicant's signature --.
CAMA Official's sign4ture
Issuing date
Expiration date
�n
Attachment: 15 North Carolina Administrative Code 7K .0203

CEDAR ISLAND, N.C. 28520
NOVEMBER21, 1994
TO WHOM IT MAY CONCERN:
I HAVE GIVEN MY PERMISSION TO HAVE A MOBILE HOME ON THIS PROPERTY.
1i-
MR. JIMMIE GOODWIN
2431 CEDAR ISLAND ROAD
CEDAR ISLAND,N.C. 28520
TELEPHONE [phone]

qpk
CEDAR ISLAND,N.C. 28520
NOVEMBER 21, 1994
TO WHOM IT MAY CONCERN:
I HAVE GIVEN MY PERMISSION TO HAVE A MOBILE HOME ON THIS
PROPERTY.
T.H. SALTER
2478 CEDAR ISLAND ROAD
CEDAR ISLAND,N.C. 28520
TELEPHONE [phone]