General Permits (3170)

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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,:'., . Phone Number
Address ' }
City ::` State Zip
P_ro)ect Location (Cpunty,,State Road, Water Body, etc.) , 4
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Type and Dimensions of Project'? d, ' J5 : - ,r , 41 .7
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.
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.
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.
Applicant signature
CAMA Official's signature
1, - f:.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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ADJACENT` RIPARIAN PROPERTY OWNER START
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I hereby certify that I own property ,adja=t to Calvin G . We l l on s 1 ,s
(Name of Prop" Owner)
property located at Island Road �
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(I,ot, Block, Road, etc.) ,
on Back Sound in
(Waterbody)
Harkers Island / Carteret Co.
(Town and/or County)
N.C.
He has described to me 29 shown below, the development he is proposing at that location,
and; I have ho objections to his proposal,
DESCILEMON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be Jllled in by individual proposing development)
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Signatxue
William R. McLamb
Print or Type Name —
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TcIepttone Number
Date: 5/23/97
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ADJACENT RMARUN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Calvin G . Wellons ; ►s
(Name of Property Owner)
property located at 8 5 6 Island Road
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(l,ot, Block, Road, etc,) '
on Back Sound in Harkers Island, Carteret Co.
(Waterbody) N.C.
(Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have do objections to his propoW.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signattu'e
David Yeomans
Print or Type Name
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Telephone Number
Date: 5/23/97
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