General Permits (7354)

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-� CERTIFICATION O EXEMPTION �
FROM REQUIRING A CAMA PERMIT la` �,"�r
as authorized by the State of North Carolina, /,P�' / 'If -tt Ta307 !y3
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 Fap: h ? 4 `k lby P, Gire od,
Address Pvsffllf (opt (6 f",tJJ) 41c, Al, l'c
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City
Project Location (County, State Road, Water Body, etc.)
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Phone Number,&4 ffw •33l► 3732-
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Type and Dimensions of Project _pT yia ii le, .1 L f',
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 signature
CAMA Official's signature
b41i',l A*A Mass,
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Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

• ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to in n W , s
(Name of ropert Owner)
property located at is a55P //s �., .� A , ,pJ A)L 91'7J
(Lot, Block, Road, etc.) '
on ro� _ �'� , in &96eyr . , 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 to his proposal.
rlLincoln
Financial Advisors®
I member oY ll—< Fi-1-1 Group
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPNIE.N"T
(To be filled in by individual proposing development)
Edwin P. Grogan, CLU
310 N. Horner Blvd.
P.O. Box 818
Sanford, NC 27330-3939
phone [phone]
toll free 800 331-3732
fax [phone]
residence 919 776-6391
,i, R d' 2001
Signature
'�>. �ssell
Print or Type Name
93g- 1 U35
Telephone Number
Date: O9-\-4—Cnk

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to's
(Name of P5 oper6 Owner)
property located at 5, //5 (? ��t , �/�
(Lot, Block, Road, etc.)
on in L , N.C.
(Waterbody) (Town and/or Count
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 DEVELOPME: 7
(To be filled in by individual proposing development)
Print or Type Name
Telephone Number
Date: -2 — l `7 — v

I � �er sr'S• i . ,
Above buffer proposd fill area
Proposed fill area

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