General Permits (7305)

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t , • CERTIFICATION OF EXEMPTION
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FROM REQUIRING A CAMA PERMIT 1/10
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environm-ental concern pursuant to 15 NCAC Subchapter 7K .0203.
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Applicant Name ` r ! ! Phone Number
Address' v^
City - State Zip
Project Location (County, State Road, Water Body, etc.) ..
Type and Dimensions of Project nzt',�r`; .'
3 r �
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 g0 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
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 r
CAMA Official' s`ig ature
Issuing date
I P I C/i
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

07/11/01 12:21 V19197907070 PATSY F. DANIELS Q 002
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to MlcI14,94 d 07s s
(Name of Property Owner)
property located at / q to /►� fir' AL h U t Pt -
(Lot, Block, Road, etc.)
on 1000 Sooey , in �p,�'aQyL� �SCC , 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 i i � ctlons to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIM[ENT -
(To be filled in by individual proposing development)
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Telephone Number
Date: p

07/11/01 12:21 V19197907070 PATSY F. DANIELS 1j003
ADJACENT RIPARIAN PROPERTY OWNER STATE MN-r
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I hereby certify that I own property adjacent to m � � ` t � Sy j� a0%"f.' s 's
(Name of Property Owner)
property located at I g i 0 ,
(Lot, Mc)ck, Road, etc.)
any LA#- SOS , in F�l d SSI� , 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)
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Signature
Print or Type Name
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Telephone Num er
Date: 0 P1 /