General Permits (5023)

I
Y CERTIFICATION -OF EXEMPTION AllFROM 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 pursuaat_ta 15-NCAC•Subchapter 7K .02,03.
Applicant Name
Address
City - —
Project Location (County, State Road, Water Body, etc.)
Phone Number •`'ys — 7f77
State X)
Zip : C4,r3 7
Type and Dimensions of Project . ', �� Jai 't t; .,� r� ' 6L, s / V0
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pur-suant tort-S;Q1CAE-7K° 0203.-This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
I !
This c�+tification 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.
(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.
Ilk S,
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203
fit:

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R atI
CERTIFIED MAIL l Q rEJ3
RETURN RECEIPT REQUESTED
N.C., tji I � f T /<GJ0u2(-cJ
Dear 5-1 z S��,:s��r S
�Ale�Yh N,C Z76'0q
This letter is to notify you as an adjacent riparian landowner of Mr/Mrs
C l w s 1 r- plans to construct I?. lA T /�� ti T
l� 1 rr,R G N i,k2!tIGA,+e %phis W 'i fide sfi•. -e. site q,S 0t9
on their property located atK a cc 0,0 .T S cs —T- .S o
in Ck C, V e r-, , NC. The sketch on the reverse side accurately depicts the
proposed construction.
Should you have no objections to this proposal, please check the statement below, sign
and date the blanks below the statement, and return this letter to: Ts lg,, Clulb jZ'
EJ P 9 7VS o. ox 79
as soon as possible. Hb V u C- E
Should you have objection's to this proposal, please send your written comments to the
N.C. Division of Coastal Management, P. O. Box 769, Morehead City, NC, 28557. Written
comments must be received within ten (10) days of receipt of this notice.
Failure to respond in either method within ten (10) days will be interpreted as no
objection.
Sincerely,
I have no objection to the project as presently proposed and hereby waive that
right of objection as provided in General Statute 113-229.
I have objections to the project as presently proposed and have enclosed
comments.
Signature
DATE:

I
I'ENDER:
.Complete items 1 and'or 2 for additional services.
I also wish to receive the
■Complete items 3, 4a, and 41b.
following services (for an
■Print your name and address on the reverse of this form so that we can return this
extra fee):
card to you.
■Attach this form to the front of the mailpiece, or on the back if space does not
1. ❑ Addressee's Address
permit.
■Wdte'Return Receipt Requested" on the mailpiece below the article
number.
2. ❑ Restricted Delivery
N
■The Return Receipt will show to whom the article was delivered and
the dale
.. -
delivered.
Consult postmaster for fee.
{
3. Article Addressed to:
4a. Artic Number
/
2
4b. Service Type
❑ Registered t1( Certified
m
/
n / t � �J
A
❑ Express Mail ❑ Insured
❑ Return Receipt for Merchandise ❑COD
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w
Date of Delivery
5. Received By: (Print Name)
8. Addressee's Address (Only if requested
c
and fee is paid)
t
H�
PS Form 3811. December 1994
rn

UNITED STATES POSTAL SERVICE
First -Class Main
Postage & Fees Paid
USPS
Permit No. G-10
• Print your name, address, and ZIP Code in this box •
p0, 'jTk, 70
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