General Permits (7758)

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
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.
[SKETCH (SCALE: )
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.
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Applicant's signature `
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

DIVISION OF COASTAL MANAGE, ME NT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION
Applicant's Name: L t i 2 2
Address Of Property: J0.cJ1C Lck n e_
gStreet CStreet 1 a�e� 8, C. & County "
Applicant's Telephone Number /0 - 7 3- (o D 76 /9/6 - 3e?- y9r!(
I hereby certify that I own waterfront property adjacent to the above -referenced property. The
applicant has p; uviucu r o A jjl � rSl �i,�,= :;f it t1:C Proposcal '�P• �2flnmont P1P P _ j the
.;. r -as in,ti
statement below if you have no objections to the applicant's proposed development. Initialling
this block does not constitute a waiver of the required IS'sethack from the riparian corridor
lines.
l/ I have no objections to this proposal.
,lam q
Signature Date
� / 0 � . Z/ 0 //J� :;E�/
Print Name and Nfailing Address
Telephone Number With Area Code
If you have objections to the applicant's proposal, do not initial or sign this form. You should
contact the Local CAMA Permit Officer listed below as soon as possible to register your
concerns:
Telephone:

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION
Applicant's Name:_ L A 2 ay 'R,
Address Of Property: 4/�2 ,J Aee fl4 m; 14a h., Lane
dns/aw
Street # Street Name ��SZFCity & County
S el(4 N� 2
Applicant's Telephone Number Q/O '] Y3. 60 70 9/0 • �9- yq 9�
I hereby certify that I own waterfront property adjacent to the above -referenced property. The
applicant has provided me.a drawing of the the proposed development. Please initial the
statement below if you have no objections to the applicant's proposed development. Initialling
this block does not constilule a waiver of the required 1 S' setback from the riparian corridor
lines.
✓ I have no objections to this ro osal.
p P
nature Date
6�
Print Name and Mailing Address
,Z7YJ- ��y5
Telephone Number With Area Code
If you have objections to the applicant's proposal, do not initial or sign this form. You should
contact the Local CAMA Permit Officer listed below as soon as possible to register your
concerns:
Telephone: