HomeMy WebLinkAboutGeneral Permits (7569)CERTIFICATION OF EXEMPTION
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 r (c
Address
City State Zip > u
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification. i y�
your obtaining any other State, Federal, or Local authorization.
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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.
—z�-�c:.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203
4
M a r - 2 6 0 G) I J P.01
2000'
PROPERT11-
A'ame of Prope�y Gwrier)
r --Ik, Road, etc.)
O!i
He )--33 dlescnf-RtJ m rune "Im'vez. '"eow, tZ t cle'veony"ment 'he is pro-X%S-; I rig -at Li'Iaircation.
DESCRIV50N, OY PR(.:,4P'OSF.D DEVELOPIiTENT
11""Y'r, flak-d in "jv v.IL';V&UalprvpOS!,-Ig dovelf)pment)
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Aftention-.
Mr, Fred -redeen
I I A
Number, 2.52-393-3075
From,
Raiph & Martha Perry
10701 Sheppards Way Dr.
Glen Allen, VA 230601
Fax Number: 804-672-11v."
APR 0 4 12000
TASTAL MANl 'Ar--'2MENT
�tOREHEAD
IMPORTANT MESSAGE
FOR
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DATE TI M EM 64c�- ��
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PHONE
AREA COOE NUMBER EXTENSION
Cl FAX
E7 MOBILE
AREA COOE NUMBER TIME TO CALL
TELEPHONED LEASE CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOUJ �` RUSH
RETURNED YOUR @
SPECIA�Al��O
MESSAGE
SIGNED
FORM 3002S
MADE IN U.S.A.
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Surveyor's Certification
STATE Or NCY7T31 CAROL /NA, C4R7ERer COVNTY
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J FRtal/ AN ACTUAL SURtirY >✓57 (MAOF UNDER MY SUPERV/S142V) I!MM.-
MAT 7W RATIO
Qc PRECISIM AS CALCULATED Nr LATITUDES AND DEPARTURES !S I010 ' /00:
THAT 7RE SCOMAR/£S NOT SIIRIl ARE SHOW AS AR61i L 1NES Pi orrev ,Rom
IAV_a1A94;i -00W /N 801 7, PAGE 94; THAT W/S AMP NIS PREPARED
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RESISTAAT 1 LW NVAil AND SEAL THIS 3/ d DAY �PFAM A. �O, 990.
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