General Permits (2424)

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Applicant
Address
City —0
Project Lc
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.--- •0208
1AP,`1C-C-,
P� . , lnP-A ES , J 2 Phone Number 07yU- 00q P_
(County, State Road, Water Body, etc.
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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.
State
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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.
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CAMA Official's signature U
In- Igj.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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ADJACENT PROPERTY OWNER STATEMENT
I HEREBY CERTIFY THAT I OWN PROPERTY ADJACENT TO CHARLES A.JONES
PROPERTY LOCATED ON ARCHIES PLACE DR. OFF THE BROAD CREEK LOOP
ROAD IN CARTERET COUNTY,N.C. HE HAS DESCRIBED TO ME THE DEVELOPMENT
HE IS PROPOSING AT THAT LOCATION AND I HAVE NO OBJECTIONS TO HIS
PROPOSAL.
THE PROPOSED DEVELOPMENT IS AS FOLLOWS:
PLACEMENT OF A 52'x22' HOME.
(SEE MAP FOR LOCATION)
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R02er ,ioRR ,
NAME
�R 9169
PHONE NUMBER