General Permits (3305)

ti
ERTIF I C ICAT ON 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
Address
City
Project Location (County, State Road, Water Body, etc.)
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.
Phone Number
State
Zip
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.
SKETCH (SCALE: )
L �.
4.
v-
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 signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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SURVEY FOR
NOT FOR RECORDING
BENNI. E
C. BAKER
50' 25' O 50' 100'
GRAPHIC SCALE --- FEET
I, Pate D. PhII1,i-ps( e�g►t�p glglfy that this map
�r},i fi// 10gm on actuol
drawn undW i�jRW-J
White Oak Township
Carteret Co., N.C.
REFERENCE Lot 21 Blk.
'White Oak Bluffs Sect. I
was
survey made � myf thud the ratio
MapBook 21 Page 88 8 88A
is lor► as eie t t I dudes and
1' • 50'
of prec
departures Is ------ oCx�cy Nat ills map was
Scale
May 29, 1998
Carteret Co. Registry
re ared iw acc rdono�e Ewddt G.SA 47 as amended
j 3eaT h is S; day-af JiU)f�, 199
Witness my� han and
L 2640
•
PATE PHILLIPS
and ASSOCIATES, P.A.
' f �
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P. 0.
Box 214
'.�•�T AIR�F:••�QS :
Swonsboro
North Carolina
uu��,��G,,,
Project No. 98126
Registered SurvergJ•Qo.Pl±�-

- ADJACENTRUPA1LAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to &e,,2,s
/ (Name of Property Owner)
property located at i a/ SLoelc 4
(Lot, Block, Road, etc.)
on Vy if i T� �/�f� i✓��L , in
, N.C.
(Waterbody)
( r 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)
Signature
4516%
Print or Type Name
Telephone Number
Date: r/ //

AIUJ Ak-l-iN 1 1uYAKiAN PROPERTY OWNER STATEMENT
I hereb
y certify that I own property adjacent to 2_— ;vm � -
s
(Name of Property Owner)
property located at lx. 4/ 61-ecK 4- 0416 IaLe
(Lot, Block, Road, etc.)
on WY1T2 o41< /Z ✓
inN. 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). '
I
0A
r r
VJ
1(t,Pr r
Signature
Print or Type Name
)\,\ a 9 A� _ n13�
Telephone Number
Date: \ � -' U

Location: field Rep.
Phone: �IU9 ( Date of Report:.4
Description of Project:
Date Proj ect Reportedly Comp-`ete :
(1)Do the measured dimensions of the development differ
indicated in the permit and
kplat?, Ye � Have
conditions been satisfied? / No
COM=NT : .
(2)
(3)
from those
all permit
SEd�Ment"a-It iOrl a?'id Erosion Control: Has pEYiTi1t-== sc=�E �
Or Ci-h-Errilse sLa-1l1ZEQ all dlstur37E^r areas. s NO
i
COM='�N T :
I
crasse-,
Future McnitOrina and Lnforcemen AC Is T further investigation
or enforcement action needed? Yes n
COUNT: