General Permits (3288)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT Cc��
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 C r/ 7
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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.
SKETCH (SCALE: ) ,
A— norc— uihn nrnnoorlc with a rlavalnnmont without tha mn-
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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Applicant's signature
CAMA Official's signature
suing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to George Adamaki.s 's
(Name of Property Owner)
property located at 210 Gull Pointe, River Bend, NC���
(Lot, Block, Road, etc.)
0
on pLAN T A I IoN CANAL , in Craven County , N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signatur
o h N LAn�,CC
Print or Type Name
L-3'7 S 363
Telephone Number
Date: _���g

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to George Adamak�.s 's
(Name of Property Owner)
property located at 210 Gull Pointe, River Bend, NC
(Lot, Block, Road, etc.)
on -f Icc �A i1Tl c , • (�\ fti 1 L , in Craven County N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Telephone Number
Date: `) )Cie

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