General Permits (8003)

+ti. ,z
CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT '
as authorized by the State of North Carolina, A&N 0 3 2005
Department of Environment and Natural Resources and the Coastal Resources Commis
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K.
Applicant Name PhoMq*pad City DCM
Address
City
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
requirement pursuant to 15 NC —AC , . This exemption
to CAMA permit requirements does not alleviate the necessity of
your obtaining other State, Federal or Local authorization.
State
Zip
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.
I 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.
v�4 nn f �1'►r cF e.�
Applicant's signature
CAMA Official's signature
Issuing date
Expiration. date
Attachment: 15 North Carolina Administrative Code 7K

(CAN
xTOWN OF RIVER BEND
45 Shoreline Drive, River Bend, NC 28562-8970
Phone [phone] Fax [phone]
Cood,* E-Mail. [e-mail]
www.riverbendne.org
December 31, 2004 JOIN 0 3 2005
Morehead City DCM
Mr. Stephen Lane
Coastal Management Representative
NCDENR
151-B Highway 24
Morehead City, NC 28557
RE: Certificate of Exemption from Requiring a CAMA Permit
Dear Mr. Lane:
As instructed, we are returning the signed blue and green copies of the Certificate to you. The
yellow copy has been retained for our records.
If you require any additional information, please do not hesitate to contact us.
Sincerely,
Ann H. Katsuyoshi
Town Clerk
Enclosure (2)