General Permits (5976)

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CERTIFICATION OF EXEMPTION
Y
FROM REQUIRING A C
as authorized by the State of North Car
Department of Environment, Health, an
in an area of environmental concern pu
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
A
d
MA PERMIT
olina,
Natural Resources and the Coastal Resources Commission
rsuant to 15 NCAC Subchapter 7K .0203.
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.
SKETCH ' _,�i _ -T y.
4 `1
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.
(SCALE:
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kr `ice
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 i
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

I hereby certify that I own property adjacent to ' is
(Name of Property Owner)
property located at /�`/<.' ,
(Lot, Block, Road, etc.)
on %U S in _ W.� ?T , N.C.
(Waterbod
Y) (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 iris proposal.
DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPMENTT
� `, gg -' �Q �E n � 1.,, 1 (To be f died in by individual Pmposinx devetoDment)
ICY /4-' z oRT ATENA
AN;, .,7,4,v OR I.4 SS
o,
1 ' J-
'_r'EP 4-
Print or Type Name
Telephone umber
Date: ��

ADJACENT RIPARIAN PROPERTY OWNER STA
I hereby certify that I own property adjacent to Au G 'As
ame of Property Owner)
property located at � �� ��,�_s,�1���C ,�/ � ,
(Lot, Block, Road, etc.)
6x , in au Qcv-c' , N.C. 2tq�Y9
(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. l4NA) -T' k0h'z 771'= ;'�
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
�9.YA ,r�ti,,i�9rfTih9ed�� OQ 1.df�S
Telephone Number
Date: U Gv(

ADJACENT RIPARIAN PROPERTY OWNER STAMJFNT
I hereby certify that I own property adjacent to /���i i3 's
(Name of Property Owner)
property located at 6 -
(Lot, Block, Road, etc.)
on C�G��ry s C,���,�c , in _ I -IL, r , N.C.
(Waterbod;y) (Town and/or County)
He has described to me as showr below, the development he is proposing at: that location,
and, I have no objections to his proposal.
E&L - 20 ---- � U��G E%t'/S/�6✓G-SL�9G✓9� L------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPYIFNT
(Tee be filled in by individual proposing development)
Signature'
9kogC r Z
Print or Type Name
3oZL
Telephone Number
Date:.. LNv 1 a G. "
V

APP-30-99 07:59 AM K"Y^S ENTERPRISES,INC. 910 326 7272
ADJACENT RIPARIAN PROPERTY OWNER STA
P.01
I hereby certify that I own property adjacent to MCz- is
(Name of Property Owner)
property located at
7W,f7C,*' f�14/,
(Lot, Block, Road, etc.
0
on jlJ, -7j s C�Pe'sK , in , u� , 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
f� (To be f fled In by individual proposing development)
Sisitature
U
Print or TM Name
85sl
Telephone Number
Date: ,.3c) l49q