General Permits (3651)

1"
Applicant,Nam(
Address l"
City /'
Proi
CERTIFICATION OF EXEMPTION OAIA
FROM REQUIRING A CAMA PERMIT Co-? i /1qr
as authorized by the State of North Carolina, (d I
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.
t r Pion r-
:t Location (County, St?te Roai
State
r Body, etc.) c. �P py <oU
l r *s-
Phone Number �/ '9 _ 7 d 5;? /
u r. !
Type and Dimensions of Project hL, r/ A �
r
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.
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: )
'` f /3(r�i;
F�
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.
A�pl' nt's 'gnature— �{
CAMA Official's signature
Issuing date
�-1..�
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
0
I hereby certify that I own property. adjacent to Mi�L.riJAA- 's
(Name of Property Owner)
property located at IJ C
(Lot, Block, Road, etc.)
on DGG� SOG�n , in C/4 P�/��T" , 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 DRAWIlVG&nF PROPOSED DEVELOPMENT
(To be JWed in by individual proposing development)
A-7TA7-c#i-=�1�
As o/0
Si e
c/ • ../GCRL_ C//�/d.t/�.f
Print or Type Name
.lue — re?.2-11 _
Telephone Number
Date:

;ANL1'
40R:�%tI�AD
k;Y 't IiE
SEA
WUEL
KONKEY
GZ
S
H
K
O
Z NC !4
i
VICINITY MAP NTS
PRELIMINARY SITE PLAN
MINDY BALIOU PROPERTY
MOREHEAD TOWNSHIP
CARTERET CO.
NORTH CAROLINA
SCALE 1"=50'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property. adjacent to W1 LriJAA- 31)z4��I 's
(Name of Property Owner)
property located at � C . 2
(Lot, Block, Road, etc.)
on in CN.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)
pa IT"6J-� E✓S/,4 ! G !�-S SRO W %o o/o
A-77-A iC#i =.D
t
Print or Type Name
C �/ r) -7"4--
Telephone Number
Date:

;ANiP
viOREHEA-D
Tay THE
SEA
qUEL
KONKEY
VICINITY MAP NTS
PRELIMINARY SITS PLAN
MINDY BALLOU PROPERTY
MOREHEAD TOWNSHIP
lyON� CARTEPRET
NORTHCA120LINA
00AT V 1 if_r--,(l'