General Permits (6439)

�O
CERTIFICATION OF EXEMPTION C /
FROM REQUIRING A CAMA PERMIT °� r
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Com ission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name C cl
Address
City
Project Location (County, State,Road, Water Body, etc.)
State
Phone Number
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.
oeveiopment.
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.
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

p EER Ft ELD SPORES SZc. 2 i
-DeED QEfS85c2-,o +14
CARD L`/l1/
1168
+
i
i l 6
.12
-
> � 1246',
1169 Q
V-h:7WTT.Y .14AP-_ N S
M, ROMANO
SCALE: /" =40'� LAARRY CBP! TTMAN R.L-S.
DATE: 2-p' �1 - 10J L- i 1. 5
LOT 2 L- OEERP1ELD SH&PES
B EA0 FORT TW P- CAR-rER E T Go.
PI TTNIAN SURV-EY Lo. P,a. Box 6o /
K EAUFOR7, h1.C- TEL: 72 Q- 3! ? 2
DRAWN BY L.C.P.
5". Z
N. C.
DRAWING NUMBER
DIETZGEN NO. 198-MF AGEPROOF MASTER FORM

1 IL-1CAMALLN YKVJrV K1' Y V WINER b1Al'EMEM'
I hereby certify that I own property adjacent t d 's
(Name of Propefty Owner)
property located at
(Lot, Block, Road, etc.)
on li►.� in &f__—_ (`— ( N.C.
aterbody) (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)
Signature
? e
Print or Type Name
7z Z- 6 / /3
Telephone Number
Date: 7 Z.31

1 ILU JAI.,=4 1 MrAKIAIN PKUPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of lFr6perty Owner)
property located at -- '��
n (Lot, Block, Road, etc.)
(Water ItL�" C -,� N.C.
( own 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.
DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Signature
Print or Type Name
?l y_ 7,;2e- 7 0 5�6
Telephone Number
Date: U

je/-

JCI
� u

Tow--� Ammm