General Permits (2381)

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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 .�;;..�'n��yl� %k�/l7��..r Phone Number
Address / e i er"r
City State Zip zsx-/c,
Project Location'(County, State Road, Water Body, etc.)y/�G
Type and Dimensions of Project ie, c '�/` D•'p el cz-.. Z' y/� ` 7
f'.�li ��-/h'� Aiii C/ _
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.
SKETCH (SCALE: )
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MEN MISSIM
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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
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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I hereby certify that I own property adjacent to
's property located at
(Name of Pr rty Owner)
�f� .✓uo�z��i S/6j2 C G.� ��-
(Iot, $lock, Road, etc.)
on I Z 4-L /C v , in � j� �/�"d � ..� f N . C .
(Waterbody) (Town and/or County)
The applicant has described to me, as shown below, the development
proposed at the above location. I understand that any construction,
excluding bulkheads, must be set back a minimum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
_ I have no objection to the project as proposed but do not wish to
waive the (15') setback requirement.
I have no objection to the project as proposed and do wish to waive
the (15') setback requirement.
I object to the project as proposed.
DESCRIPTION MD/OR DRAWING OF PROPOSED DEVELOP:�'T:
(Tb be filled in by individual proposing development)
-Z6ed- t�) C
r
Print or Type Name
`16- 12S3 61, �')(
Telephone Number
Signiatu e
Da

• � �a ... • •.s • a• r ia• r a is
I hereby certify that I owm property adjacent to
's property located at
(Name of Property Owner)
(Lot, $lock, Road, etc.)
on i�%P_cl S� �i vet /tYG.P"e-e—/ ctm N.C.
waterbody) (Town d/or County)
The applicant has described to me, as shown below, the development
proposed at the above location. I understand that any construction,
excluding bulkheads, must be set back a minimum distance of fifteen feet
(15') from my area of riparian access unless waived by me.
I have no objection to the project as proposed but do not wish to
waive the (15') setback requirement.
I have no objection to the project as proposed and do wish to waive
the (15') setback requirement.
I object to the project as proposed.
DESCRIPTION KND/OR DR',1%7ICY OF PROPDSED DFJE.0p �==I :
(Tb be filled in by individual proposing develop�-nent)
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Print or Type Name
(fly I 2-Lf9— t6irsn
Telephone Number
C�
ature
Date