General Permits (3510)

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.
f
Applicant Name Phone Number 12,. O
Address
City =p State zip
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.
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: )
)�1 4,L. l_.
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.
I
�7 F L. 4
\\J ice- '1• i_ Y ``• � q
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

Message Conf irmation Report
Name/Number
93283788
Page
1
Start Time
MAR-30-2007 10:57AM FRI
Elapsed Time
00'16"
Mode
STD ECM
Results
[O.K]
MAR-30-200710:58 AM FRI
Fax Number
Name
v CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Rosources and the Coastal Resources Commission
In an area of environmental concern pumunnl to 16 NCAC Subohoptor 7K .0203, 'r 3ZA, 3-) a a
Applicant Name :::G o ft 1w1 �� Phone Number SIR 1?_� ID
Addresp Z3-M- oy-wr . f ,? a 4 a— Z 17 1
City t>g;rs�' State ,' . Zip7,91A InQ
Project location (County, State Road, water Body, etc.)
Type and Dimensions of Project E �ti+ z�� Nw, �'s to N A _'ram F� AMri N 5 a
�titiL�v mansions
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permlt Is
above Is hereby cortiflod as axompt 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 ra•examination of the project and project alto may be necessary
LAMA permit requirements does not allovlole the necessity of to continue this conlflcation,
your obtaining any other State, Federal, or Local authorization,
i I 1 i
j C) L "L ON I- q p M6 li 1 \A 1 JS `Z r tJ
�1��VV
t9>.lty
ph� t u li1V f F\.G.
;�L L
.7eyl vi'-� r"
'(�f p 0.A J A
1
i
Any person who proceeds with a development without tho 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 oubaoquonl determination that a permit was required for the
development.
The applicant cortHlos by signing this exemption that (1) the ap-
plicant has road and will abide by the conditions of this exemp•
lion, and (2) a writton statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work,
�x:ant'e signature
ILS -` 4
CAMA 01fic7al' signature
ignature
Issuing 4lata
II- J•o.7 0
Expiration dato
Attachment: 15 North Carolina Administrative Coda 7K ,0203
T