25775_KING, JOHN & GAIL_20000810 (2)

A . 5.
O
Applicant Name
Address
City
Proiect Locatior
CAMA PERMIT
as authorized by the State of North Carolina, neck Ar,'�ENT
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapterdlq@h@M. _ r • .=
Y,
r ' �Z•` .'i Ili � !, (:t..,;
State Road, Water Body, etc.)
A < I' ?,j 1'- r t'
Type and Dimensions of Project
The proposed project to be located and constructed as described
above MOM. This ,ema►
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number
Stater Zips
G,r rc%
This 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 Altiw ified n.
SKETCH
(SCALE: )
V Na
I
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 swoompkewthat (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 r
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code PIM(r'