General Permits (7140)

Applicant Name
Address
CERTIFICATION OF EXEMPTION �-
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and the Coastal Resources Co is ion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Phone Number
City State Zip
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.
This certification of exemption from requiring a CAMA permit is
valid for 60 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
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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
Ovelopment.
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

LARRY STYRON "-152/631 6831
SPECIAL ACCOUNT
P 0 BOX 1402 726-8907
MOREHEAD CITY, NC 28557
PAY TO THE
ORDER OF
WNrUnW-A DOLLARS
Wachovia Bank of North Carolina, N.A.
Morehead City, NC 28557
FOR
1:0 S 3 10 IS 2 91: 5464 2?5436iis 6 83 1
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BEAUFORT, N.C.
CARTEPCT COVHTV 4COU T HOUSC
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify
that I own property adjacent to
located at ��� .
propert in (county) c',�7 t ,
(water body)
He has
described to me as Shown h below
no®objectionsnto this
proposing in that location and Z a
proposal.
If
Description and or drawing of proposed development:
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28516
BEAUFORT. N. C.
7t_ z
CARTCRCT COUNTY COURT NODS[
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
that I own at party adjacent to
I hereby certify ,� /2 '-
v�property_locatsd c� { �-
� , ,,_ ,�� /y %���,ti in (county)
(water body), ed to me as shown below the odbe 810P snto this
SHe has described
proposing in that location and Z have no
proposal.
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cri tion and or drawing of proposed developIDent:
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