General Permits (5512)

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CAR 1;GAT- fO N, --_QF
FROM REQUIRING A CAMA PE
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural R
in an area of environmental concern pursuant.to.1.5
Applicant Name -a ,': J•tf
Address
City
Project Location (County, State Road, Water Body, etc.)
EXEMPTION c e$
RMIT
esources and the Coastal Resources Commission
NGAG Subchapter 7K .0203.
Phone Number /
�.�
State .4) G- Zip
Type and Dimensions of Project
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90zdays from the date of issuance. Following expiration,
quirement pursuant to-1�5 NCAG7K .0203: This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
nt seof 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-
Applicant's signature
� f
t
CAMA Official's signature .
Issuing date
i;Y_ i
tion, and (2) a written statement has been obtained from adjacent
landowners certifying thatfthey have no objections to the..
proposed work.
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

r ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ✓ ' AG1= s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on ,So &U,' Soyn113 , in V1/g1;q, 04A 7dWAISN116 C-I RtrR�T�v. 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)
30o F�
A D
Si e
Print or TYP& Name
�/J
Telephone Number
Date: � —/ 7 -

r
I hereby certify that I own property adjacent to -DE V,// 7- -7 is
(Name of Property Owner)
property located at �/� 9
(Lot, Block, Road, etc.)
on ,DOGy� So cl AJ D , in 17E OAK `o �i✓SH� 1° cA�Tc�RP- i', 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)
"qPPkox soo FT
Signature
J3 �=
Pri/ntt orGType Dame f
J /_�y ��J
Telephone Number
Date: V' / o 2 2