General Permits (3504)

O
CERTIFICATION-0F EXEMPTION /' V,V/ 4 '' I
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 ✓�� • . ��-L,. -.
City
Phone Number
State ,V c- Zip
Project Location (County, State Road, Water Body, etc.) ; f. -,,, f F`�. of
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.
s
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.
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
LAMA Official's signature
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

0718,,98 SAT 11:33 FAX [phone]
Fpkl!.l, ' :5LIrLBELT
John F Pholeric, Jr.
�HCFNE 1,40. : 2.a9 1�15
Jul. P-3

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P 599 756 336
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International Mail See reverse
Sent
Street & Nu ber
& ( ? .SDv.;7r -111/
Pos ice, State, & ZIP Code
- F7i�jD2 rA �4
Postage
$
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing to
Whom & Date Delivered
r
Rehm Receipt ShowinaliaAlga
Date, & Address d
TOTAL P s,
Postma to
itSQS

_ _.CERTIFIED MAIL_
RETURN RECE r REn11STED
Dear
This�otter is to notify you as an ad'acent riparian landowner of N r/Mrs
plWIs to construct
on their pj°perty 1 ated atJ T ry
�
in —, NC. The sketch on the reverse side accurately depicts the
Proposed construction.
Should you have no objections to this proposal, please check die statemc;►t b�.'ow, si �J��;
an date the blanks below the statement, d return this letter to:y5.¢,J
Uv �O T /, /Il' S"7/
as soon -as possible. 711-
Should you have objections to this proposal, please send your written comments to the
N. C. Division of Coastal Management, Hestron Plaza II, 151-$ Hwy 24, Morehead City, NC
28557. Written comments must be received within (IQ.)days of r rein of this notice.
Failure to respond in either method within (101 days will be interpreted as no objection.
Sine ely, 1
j
I have rto objection to the project as presently proposed and hereby waive that
Fight of objection as provided in General Statute 113-229.
I have objections to the project as presently proposed and have enclose.i
comments.
Signature
DATE:
ra

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
0 Print your name, address, and ZIP Code in this box •
90cil_%1

TENDER:
■ Complete items 1 and/or 2 for additional services. I also wish to receive the
■Complete items 3, 4a, and 4b, following services (for an
■ Print your name and address on the reverse of this form so that we can return this extra feel:
card to you.
■Attach this form to the front of the mailpiece, or on the back if space
X
PS Forrf13911-December 1994 J&595-97-B-0179 Domestic Return Receipt

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E
LL
a
P -'99�756 337
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Uo not use for International Mail See reverse
S t to -12 ill,s.
St t &Number
o Office, State, ZIP Code
v (-f t7S7 x 30
Postage
$
Certified Fee
1
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing to
Whom & Date Delivered
to
Return Receipt Showag to Whom,
Date, & Addressee's Address
TOTAL Po
Postmark
1998
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