General Permits (4151)

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G E - R,TIF1OATION"'O.F 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 persuant-to 1,5`NGA'G Subchapter 7K^;0203.
Applicant Name
Address 7,1, r r .
City
Project Location (County, State Road, Water Body, etc.)
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Phone Number
State Zip
Type and Dimensions of Project - , A,, / ; 4-', , , ,. _?;� " %1 /
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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-NOAC 7K-020& This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certificatior1of 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.
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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 tothe.
proposed work.
Applicant's signature '
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CAMA Official's signature
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Issuing date
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Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at 173 S g LTCk M , /U'5�w✓o x7' /,rc
Ut, Block, Road, etc.)
on 06 U li SU (/ N� , in 8RO C�' ��XTgtT 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. —� Z o
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in
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by individual proposing
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Print or ype Name
Telephone Number
Date: / 0 /© - 7 b