General Permits (5784)

01
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.)
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.
Phone Number
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.
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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

I hereby certify that I own property adjacent to ,s
(Name of PropertyOwner)
property located at „d ,
(Lot, Block, Road, etc.)
on in ��, ,/��' �.�_. , 0 rr ?, , , N.C.
(Waterbody) 7 (Town and/or County)
�S2 9
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)
4ig7fature
0
l a
Print or Type Name
Telephone Number
Date: i ; � �

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Dear C2�
U JUN 1 6 1997
�.
This 1 ter is to notify you as an adjacent riparian landowner of Mr/Mrs
plans to construct Cz /DD o�-'/,-Ze�
on their property located at
in , NC. The sketch on the reverse side accurately depicts the
proposed construction.
Should you have no objections to this proposal, please check the statement Wow, sign
and date the blanks below the statemen and return this letter to: ,c
as soon as possible.
Should you have objections to this proposal, please send your written comments to the
NC Division of Coastal Management, 151-B Hwy. 24, Hestron Plaza II, 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.
Since -rely,
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.
Sig ure
DATE: %' 9 %

to
' J U N 1 61997

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