General Permits (3652)

Applicant Name
Address.
City
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 Commissior
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Phone Number
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.
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.
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
development. CAMA Official's sig ature i
=n
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.
date
Ct
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

Permittee's Name erm
Location: Field Rep. LO
Phone: cj,�(��� Date of Report:
Description of Project: �� Q a I/SEC 7-a 01 ZYJ
Date Project Reportedly Comp rtte:
(1)' Do the measured dimensions of the dev nt differ from those
indicated in the permit .and��reJ� kplat? Yes No Have all permit
conditions been satisfied? c(/ / No
(2) Sedimentation and Erosion Control: Has permi e eeded, grassed,
or otherwise sta:-,ilized all disturbed areas: es / No
COY24ENT :
(3) Future Monitoring and Znforcement Ac ".0 Isrfurther investigation
or enforcement action needed? Yes
CO=NT :
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PROPERTY MAP
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CARTERET COUNTY
NORTH CAROLINA
SUBDIVISION INDEX
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 3-oN N £ PA n," B u 2N ETTS 's
(Name of Property Owner)
property located at 2'1+ o`D CAusrl.vAy RD, 80AVFoltrNc (Lots !S-{h = i CG 14,
(Lot, Block, Road, etc.)
on 13EAur-c-ax HazisoR (19411 , in CAaT-E-MCr Cou Nry , 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 DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Tr-> C-NsTRUcT A P/t12.. 3' 1-0 4' wibg AND So'7-D loop /Aj
PL-ATFrt w,
L. EN GTl-1 1=P-o►, E y- Sn /y G ) IN -n4E `iP PP-0 X./ rni}rtF
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SEP?51997
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Signature
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Print or Type Name
Telephone Number
Date: L'-p%

. ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to To k N A PA m eLn B t o-t4 77"t I
(Name of Property Owner)
Property located at 2-'7 4 o LD CA u s E-uay R D B Ewv r-oa s ,v c (L.T5 1$ - pi E i or 4
(Lot, Block, Road, etc.)
on B"u ►=o f-r ",q2 ►3 o ►z Ll -T 44 �, in
(Waterbody)
Cop- TE'9 t_ T Co u rq rY
(Town andlor County)
N.C.
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)
Tb Co N S 7t2 u c i p P/ E)Z 3' TAD 4( WIDE A µ D SO' 7ro Too ` I N
P I-AT-Fv a M,
LL�AIGr►-t (Plz-on r-)L►snti& ) /At 7-WiE F}PP2ok�n►R%�E Loc,�nonr
dF P12EY►ovS PIOZ, P/69 WILL- f3E d9PP20YJ,-ngrZ—.y /ZO' 02oM
PR.oPEzT-Y L- ►NE 8e-rwee-,\l ovlC PRoPiz)znEs:
w la I T Le-*_
[e-mail]
SEP 2 5 1997
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Print or Type Name
9/ 2- 'T� 9-- 7 3 ,
Telephone Number
Date: 9 —' 5 — C? 7