General Permits (3503)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT w
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: )
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.
,f:
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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hereby certify that this map is correct and
prepared according to the Standards of
Practice for Land Surveying in North
Carolina, and that (there are no property
line encroachments either way on said
survey,-Ihuapropertyd-linacsn=omchmentr
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THIS AP IS NOT FOR RECORDING.
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SURVEYED BY DATE
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NOTES
1.)
AREA - 16'347, 67 3•F.
2.)
CLOSURE - 1:10,000+
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FLOOD ZONE 'C "ASt -,cL 7 ftgr F./ P,y
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6.)
FINAL MAP RECORDED : PWE' /777
7.)
THIS PROPERTY IS SUBJECT TO ALL
EASEMENTS, AGREEMENTS, AND RIGHTS
OF WAY OF RECORD PRIOR TO THE DATE
OF THIS PLAT.
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COUNTY CITY TOWNSHIP
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SCALE DATE PROJECT NO.
eE,-- / 7 11977 770/53
9rrstigr
Engineering and Land Surveying, P.A.
101 Manatee Street- Cape Carteret
Swansboro, North Carolina 28584
919-393-2129 (Fax)919-393-3075

Loca ' tion. -'2C'5:6 s Field F.ep.
Phone: �C�`1 3C� Date of Report:
Description of Project: 5
Date Project Reportedly Complfftte : 2
1 Do the measured dimens ions of the development- ' i f " ( ) _ p _�a__zer from those
indicated in the permit .and = kplat?, Yes / to Have all per,�it
conditions been satisfied? Es'/ No '
COUNT: I
(2) CE1r1EntatlOii acid Erosion Has
r1�ErIiI1t_ sE=`E=� Crassc^�
y NO r
Or C'��ierwisE staL11ize'd all disturbed areas:
COICf ENT
t
(3) Future Monitcrinc and rnfcrceme'.'it P_ctl n: ` IS fi'_t-t.ner i rives i `i Qat1OP_
or enforcement action needed? Ye /
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