General Permits (4711)

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,
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
State
Phone Number 5 +
Zip
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 c. rtification 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:
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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 to the
proposed work.
t\LIGNkiEW7—
P
pplicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

MAR.-04'99(TNU) 08:47 COMMUNITY MANAGEMENT TEL:[phone] P.002
MAR. -03' 99 (TUE( 16:20 UC8 MORTGAGE TEL:919 P. 002
"jA EN i Rl:PARIAN PROPERTY owmm STAT, ['
I herbythat I awn property adjacent to
(Name of operty �:r)
ne Iocated
(W.
He has
and T have no
k k M
L
(Lot, 1rSznt, Road, etc.) V
iI
dy) N. C_
(Town and/or Cotmty)
tlhed try me as shown bc?cw. the development he is proposing at that 1, catron,
:bons to his F ,;
'ION AND/oj�_ '.';'_A.y.7-�TG OF PROPOSED DEVEWpMENp'
(To be fiz?e,-' u��vfr�zial proposinz development
91
John T. Eagan, Jr.
Print or Type Name
[phone]
Telephone Number - --
Date: March 3, 1999

(FOR A PI OWNER �T �
a
I herebY esrt"y that I On wry adjacwt to
`S
R" �� (Marne ®f spy Owner)
Fly located aton
(Lot, Block, Road, etc.) ,
('�'etterbody) m
(lawn andoor N.C.
He: has described to me, as shown below, �e development he is
laca�ion, and, I have no objections to hisunderstand
proposing at that
must be set bads a aruniMUM distance of fifteen feet (I )� � a /unco ►sad }mot Sift
waived by me. Y area of riparian a=Munless
IdLWwish to WRivee the setbm3c requirement.
.tQ wish to waive that setback requirement.
DESCRnMON AND/OR DRAW]NG OF op'O
(TO be , ffl d airs by ix&vidual PruPaszng development)SED �:
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Print 'or T�pe Maine —
Telephone umber
Daze:

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