General Permits (7316)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, t'''f
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 Y"4 r),d�*
Address !'i�v Vrv, P.1,
City State
Project Location (County, State Road, Water Body, etc.)
Phone Number t .f `
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_ Zip
Type and Dimensions of Project -i For 4vC AIWI (fiJ,r~,! ..•tfolf, b"i %r"^�''. ,� A 1111 ,
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.
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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 signatu4
CAMA Official's signature
Issuing date
. .i
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

raarJ,%%-1WN"1' MFAKIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to PqT/ (>��G is
(Marne of Property Owner
property located at
(Lot, Block, Road, etc.)
on ���� (Win G ,-- �--
aierbody) (Town and/or County)
He has described to me is shown below; the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPN EVT
(To be filled in by individual proposing de),eloprncent)
?671
post-ir Fax___
I�toro
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Signature "
Print or Type Name
0 5-og 3 3 - 6 ?/O
Telephone Number

rwV'q—r.1N'1' xtYAuAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Fame of Property Own
property located at L i
(Lot, $cock, Road, etc.)
on in
(Waterbody) N.C.
(Town and/or County)
He has dc='bed 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 DRVIELOPrvIENT
(To be filled in by individual proposing development)
Post -it* F3x
Noie 7671
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Signa e
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Prin or Type Name
7elt ne Number

HOLNAM INC
SANTEE REGION
HOLLY HILL, SOUTH CAROLINA 29059
AC 803, 496-5027
S.C. Toll Free: 1-800-922-7001
Out of State Toll Free: 1-800-845-7051
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MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PERMITTEE'S NAME: Pal DKd Iry PERMIT # Fxrmd4i,
LOCATION: ygy VFW Rd FIELD REP. SL w-
Cane (ar ftyv
PHONE: 313 - S 2. ►2-
DATE OF INSPECTION q-13 -0
DATE REPORTEDLY COMPLETE: 7
1) measured dimensions of the development differ from those indicated in the permit and workplat?
q�* [circle one].
COMMENT:
(PMa irtr
/1
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? YES&[circle one]
3) FUTURE NITORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? /NO [circle one].
COMMENT: (Ae�k 4 a4,r(ct 14* c / rook 141 l/