General Permits (2363)

Phone Number % / (/ 64 7-o
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.
' ' CERTIFICATION OF EXEMPTION
FROM REQUIRING A 0r'.."A PERMIT
as authorized by the State of North Carolina, r6
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 N
Address
City
Type
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.
SKETCH
_- -
jl _.._
is {'
r
Any person who proceeds with a development withou the con-
sent of a CAMA official under the mistaken assumptio that the Applicant's signature
development is exempted, will be in violation of the CA A if there
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

-90 -
ADJACENT RIPARIAN PROPERTY OWNER STATENIEW
I hereby certify that I own property adjacent to
�o C 14 A w% w\ 's property located at
(Name of Property Owner)
SF C '7 59',.eg i, ld
(Lot, Block, Road, etc.)
on `V Q2-1� cuts 1 cek , in WF-� 13 Foi C teoo" , NC
(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 be filled in by individual proposing development)
Print or Type Name
_ 6 13
Telephone Number

0 v co
I I
EE F _ —,— _ — i rya
? _ � l PAST � 14S
_ _ 7 I I IPAGE
au6c-�
i
J
f E G o 5 E UT I O I I :�1.7
�ovE IMOd I,FAGe I70 I I 12� 11 p: I
i 1 t _GASIO�c BO I3 I r 13
I I CE�Oevev 111, �I 59 I Z58 I 257 11 1 2S6 25S Co6•'Oo
ae.00
1� 1 I I Z61 I� 26o I Z II 30'03 , I go.o8 80 5 Zg� 33' 02"
1 t'O4 �I co5. p8 I� ?5 08 ,( \ ° •�
5 , 2 I ��II I I o8 I ?S GB 1 1 00 •c r
I 8 0 N_
\\ 1� I1�` E • �I 8o•oa Boob �o -0 3 Q - o � _ p O Q _
0�5 5 7&•`�? N S o -$ co - 0
q p Q t- to N Q
�9 U` 0 0
o _ o � N � � � N = N - O � _ N •
�, L4 1- lr• _ 4�
80.43' o sN 7S. 89' -TS. 38' `� (�O
i0.
06 OS K'
2� ru ti U =� ? =� Ncl� co 0
s� so.3D
1 4, PI)u 4J '�9 O - �9 g 0. 01
3u
V,in . -0 0- t
o d
` (-I Ai m (l/ p o N ap
V U o ° - O t 141
rn
� m
i- q
ivZz
-4 .

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own properly adjacent to
I )() C, 0'tJVVt jvL is property located at
(Name of Property Owner)
0
(Lot, Block, Road, etc.)
7
on /� w rya 1 , in AJ Qru 4!!� 2,aw- _ , NC
(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 be filled in by individual proposing development)
Print or Type Name
Telephone Number