General Permits (2399)

CERTIFICATION OF EXEMPTION 9
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 n V. `C "e7ro/ E.
Address �
City ! /
Project Location (County, State Road, Water Body, etc.) .
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Phone Number 5
State NC Zip ,289'71
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The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
— f C111.
I SKETCH (SCALE: ) I
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted, will be in violation of the CAMA 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.
10t! V
Issuing date
Ak A
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJAM'QT RIPARIAN PROPERTY EWER STAT124ENT
I hereby certify that I own property adjacent to J-0 170 al?0/
Laf'01 Z. Ale07017 's property located at 52 wlocl CUU/'t
lot, ock, read, e
on ` #71117 Creeg� inn r/et'l 74a / , N. C.
body of water town and/or county
The proposal has been described to me as shown below; the develognent, a
e �,�alkhead/structure, and the proposed location, and I have no objections
�A (circle one)
to the proposal. I understand that if the develogres7t is a pier, it must be
set back a minimum distance of 15 feet from my area of riparian access unless
waived by me. I d do not wish to waive that setback requirement.
Description and/or drawing of proposed development: (to be filled
in by individual proposing development.)
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(Original must be retained in the InE ection Departrr,ent)
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Signature
Name (Please Print)