General Permits (7225)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,Cfl"\\
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 M At 1< r Phone Number -72 9, -
Address
City n c`�,.�. State &J Zip Z91s
Project Location (County, State Road, WaterBody, etc.)
Type and Dimensions of
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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 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.
I SKETCH (SCALE: ) 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 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.
0
Applicant's signatur
d,.�—t
CAMA Official's signature
issuing aare
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

` NOV' CONSTRUCTION I ) APPLICATION FOR IMPROVEMENTS PERMIT
EXISTING ( ) AREA
REPAIR ) ENVIRONMENTAL HEALTH DIVISION
CARTERET COUNTY HEALTH CENTER PRIORITY
BEAUFORT, NC 28516
DATE:
OWNER • IkL-Jk094_ AM A i 4k's PHONE: PIy�. l
ADDRESS t lop t,�� A c A7� P� Fy2-r� pS C agsl(
APPLICANT/AGENT PHONE:
ADDRESS
SUBDIVISION LOT BLOCK SECTION
PROPERTY LOCATION
TYPE STRUCTURE CONCRETE FLOOR (YES) (NO)
NO. BEDROOMS NO. BATHS NO. PEOPLE GARBAGE GRINDER: (YES) (NO)
WATER SOURCE FLOOD ZONE ELEVATION
TAX PARCEL #
ACTION ON THIS APPLICATION WILL NOT BE TAKEN UNTIL THIS OFFICE HAS BEEN ADVISED THAT THE HOUSE AND PROPERTY LINES ARE
STAKED AND THE LOT IS ACCESSIBLE FOR EVALUATION.
"NOTE: THIS PROPERTY MAY CONTAIN DESIGNATED WETLANDS. APPROVAL FROM U.S. ARMY CORPS OF ENGINEERS MAY BE REQUIRED
PRIOR TO DEVELOPMENT. ADDITIONALLY, CAMA PERMIT SHALL BE REQUIRED IF ANY PART OF THIS STRUCTURE, SEPTIC TANK OR
POTABLE WATER SYSTEM IS TO BE WITHIN 75' OF SHORELINE, CANALS OR OTHER WATERS OR MARSH.
s
"' IMPROVEMENT PERMITS ARE VALID FOR 60 MONTHS FROM DATE OF ISSUE. THIS IS NOT AN IMPROVEMENTS PERMIT.
IMPROVEMENT PERMIT SUBJECT TO REVOCATION IF SITE PLANS OR INTENDED USE CHANGES
SIGNATURE
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