General Permits (2973)

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GE
R_ T-1 F-AfATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT WV r4
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 Nameg„76i E Phone Number yid. 39.3-a L'09,6
Address if 70 +`ra��s;�l 144.
City Sc„te,-'gAvon State Zip
Project Location (County, State Road, Water Body, etc.) Q4&9,
Type and Dimensions of Project
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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 ce ifrf` icaTion4oef exemption from requiring a CAMA permit is
valid for gQsdaWrom 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.
Applicant's signature,
CAMA Official's si ature
5-2- 77
Issuing date
-2--?` 97
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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Adjacent Riparian Property Owner Statement
I hereby certify that I own property adjacent to: Joseph S. and Linda Temple., property located at Silver
Creek near the White Oak River in Carteret County.
The applicant described to me as shown below, the development he/she is proposing in that location and:
I have no objections to this proposal
I do have objections to this proposal
Description and/or drawing of proposed development:
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extra fee):
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Adjacent Riparian Property Owner Statement
I hereby certify that I own property adjacent to: Joseph S. and Linda Temple., property located at Silver
Creek near the White Oak River in Carteret County.
The applicant described to me as shown below, the development he/she is proposing in that location and:
I have no objections to this proposal
I do have objections to this proposal
Description and/or drawing of proposed development:
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Signature
Name
Phone Number
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