General Permits (7365)

1 40
CERTIFICATION OF EXEMPTIONW`�
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
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 Phone Number
Address
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 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.
2 r'
SKETCH (SCALE_ J ) 1
r
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
LAMA Official's signature
development.
The applicant certifies by signing this exemption that (1) the ap- Issuing date ,
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 Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203

12/18/00 17:34 V919 243 4364 AM WOODLAND Z 001/001
Dec 18 00 04c29p Eddy Myers y19-72t3-sous p-,
NOV-30-200D THU 04 ; 57 PM NC Div OF 00K-)TPL 14 W f g 11. 25224 3='i
CIERiI L _*R.EJC1 ,4B ;�. S-11P
DPnSION OF COASTAL ti kNAGEI� :S
ADJACE`T RIPARIAN PROPUTY OWNER ;OTIHC Taft INIWAIVER FORM,
Name of IndividW applying for Permit, --
Address of Property: -- — -- —
(Lt or StfC::� ., Sty- : 41 Road, Y E County)
I hereby uetfy Char I own p,op:.,y adjacent to th4 ab ve re:e-e e:i grope:,y. The indivicl-. +l
F.pplyin; for this permit has d•_sc- bed to me as sh:ran c i the atta irawirie the de ie'opm t
t sty a Qropos g. A descr-�pdon or drawing, with d =5'40ns, wit .d be provide with i. s
have no ubie:ticns to this propcs�r.
1f You have objections to what is being prop ),2d, 9lease w e . ie Dt'vision o F Coa-,.i '
Ma►rVenrenl, HettMir PAW 17, 151-0, Hwy. a, 02rei Id Cizv, C, IS 7 or call (2=3) $';'-
2306 wuhin 10 days r f receipt of this nonce, No repo,7t; is cois&. d t it sarze as no ooject,,
if 1•ou have been noalted by Cerrifted Nail,
WAINTR SECTI( S
I eade:stand that a pit::, dock, moo;ino piimp, breapa"at, , boat ho I i or vindhaL•a be
i.: back mini stance 0; l3' :,om rry area of r.Yari 1 acctss t es waived by M., (!' tioe
u- �a r a set uic Initial the appropr,at blank be v. )
I wish to waive the 1 se -back itnt.
n"atve the 1 Y setbac!c re: :irement.
5 iPat
gin am r
Te:ephOne Number WAh Area Codc w~
l �o

12/14/2000 THU 14:27 FAX [phone] C.P.E.U. 0001
CENTRAL PERMIT OF'FfCE OF
COUR-1 HOUSc SQUARE
B_AUrORT. N. 2551 6.1 a9a
725-55=5
H (:IL71NC G. Mri ?IL1 Y+CMc-3 5'-r_-AIC- L. P-11M91NC. MECMANICAL
ADJACENT RfPARtAv PROPERTY OWNER STATENMENT
1 hereby- ceiii that I own propery adjacent to:
io�4�:-au zt: .2 s;o L ENq/07IL1 GaL �c�o ____ near
body) T :JLQXs C^CA, t in (county) q:zrt,rrr,— c ,
The applicant described to m: as shown below, the development he/she is proposing in that location and:
I have no objections to this proposawGf
I do have objections to this proposal
J?escription and drawing of pro129sed development including Drot)er:v lines. setLacR-s from each line
size of proposed construction, location of water and an- other structures on 12r_2perry
^r C,-/
13sn�'�)
Phoneyu nber: 42
DateC IR (f 3 G G