General Permits (2479)

Applicant Name -
Address r
City
Project Location
CERTIFICATION OF EXEMPTI
7�1
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina, APR 1 3 199
Department of Environment, Health, and Natural Resources and the Coastal Resou'r,� n
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K.0 20,i,3
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�yj1"4 I C t 1� � t p r Phone Number
State Road, Water Body,
Type and Dimensions of Project
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.
Zip
This certification of exemption from requiring a CAMA permit is
valid for46=�tjfrom the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: !'J / ,n'_ ) I
i
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.
JP, ­izi-D
re
L,HnnH vniciat s signaiure
�4
Issuing date
/9'S7
Expiration date If
Attachment: 15 North Carolina Administrative Code 7K .0203

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THE UNOERSIGNED HERE BY ACKNOWLEDGES
THAT THE LAND SHOWN ON THIS PLAT IS WITHIN
THE SUBDIVISION REGULATION AND JURISDICTION
OF BRUNSWICK COUNTY AND THAT THIS PLAT
ALLOTMENT IS MY FREE ACT AND DEED.
0-WYER'5 SIGNATURE/
APPROVED BRUNSWICK COUNTY PLANNING BOARD
CHA114MAN
NO FLOOD INFORMATION AVAILABLE
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A-10 T E : LOTS ,4 ,2E S!/BJE c r Ta .C'E ST,Pic 7-1,) 'S � 'c CG 2
/iv 4--/9-f'v'S. 3u`'Z a-- _3r!'i 9.
JAN K. CERTIFY THAT THIS PLAT WAS DRAWN BY ME
FROM AN ACTUAL SURVEY MADE UNDER -MY SUPERVISION , THAT
THIS PLAT WAS PREPARED IN ACCORDANCE WITH G.S.47-30 AS
AMENDED. THE ERROk OF CLOSURE IS I:: �p0 AS COMPUTED
HY T.HE D M D. METHOD. REFERENCE DEEDS $•/OR PLAI'I.:
WITNESSMY ORIGINAL SIGNATURE. REGISTRATION NUMBER AND
SEAL THIS 1;f- DAY OF A. A.D., 1987
MAP OF
LOTS 104 Amu IOS
Go PAS SH02ES
FOR
SHALLOTT6 TOWNSHIP BRUNSWICK-COUNTY, N.C.
SCALE: I" 40• r-) AY 4-, 1987
4-o' 0 ¢a' 8 0' 12°
SCALE IN FEET
JAN K.
DALE
(/N.C.REG• N°
L-1250
RT. G ,BOX 1000
Palle-
J3 R�JNSWICK CULLN_j_j NO RTH_CAR LQ I N A
I,A NOTARY PUBLIC OF THE COUNTY AND STA-E AFORESAID,
CERTIFY THAT LAN K OA'_E,A REGISTERED LAND SURVEYOR,
PERSONALLY APPEARED BEFORE ME THIS DAY AND ACKNOW-
LEDGED THE EXECUTION OF THE FOREGOING INSTRUMENT.
WITNESS MY HAND AND OFFICIAL STAMP OR SEAL, THIS _
DAY OF , 1987
2-L*-7
MY COMMISSION EXPIRES
NOTARY PUBLIC