Mouser

CERTIFICATION OF EXEMPTION
T
' 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.
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Applicant Name ou Phone Number 1 161 615.— j
Address_ lOas Pow iN£+nr\ OAC1 � t
City ^\%et ` Iv
State CI e`Zip --klao
Project Location(County, State Rom', Water y, etc.) nsl� L7OU nfi�1 CQQ�3C) +� Sf�ir d f
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Type and Dimensions of Project .. ut 10h.C41d Ift(e..4 ')&1\'f f 1)0C k-- 1 0' `XOE f
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.
your obtaining any other State, Federal,or Local authorization.
SKETCH (SCALE: 'Jo-T. )
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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 ApplicaN's signature
development is exempted,will be in violation of the CAMA if there v
is a subsequent determination that a permit was required for the CC:1)
development. C MA Official's 'gnatu
ce
The applicant certifies bysigning this exemption thatthe a ��
PP 9 9 P (1) p 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 ‹ .N5 1 1 lG�j,V

05/18/98 08:36 a 910 392 4406 GLOVER-Erwin NC 01
U5/18/96 10:20 1919 553 3301 MOUSER PAINT CO- Pg. U2
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NORTH CAROI. INA, 28446
ADJACENT RIPARIAN PROPERTY OWIIER STATEMENT
•
I hereby certify that 1 own property adjacent to i1'tau rkcr p.; Lae t Cii ,.-t-r's
��, (Name of Property Owner)
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property located at. (AL, 3 l7 r f- C.L i'y. - -- ,
. (Lot, Block, Rood, etc.)
on e luAj c (. ovid. I , in . >e*r•P Cs ii (Iv vShi/ ei„„ iy NiC,
•(Waterbody) (Town andior County)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objectio»s to his proposal.
• DESCRIPTION AND/OR DRAWING Or PROPOSED DI VELOPMENT
(7'o be filled.in:by.tndhvidtw1 propOShtg developmen )
•
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4'' co Signature .
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Print or Type Name
w . JJJ J )JLJ" fl[j __ felepho Number
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(Jr;��. Date: f�fA `
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the,Jai C/ r
L VANCE E.KEE,MAYOR
-1 = CITY
NELVA R.ALBURY COUNCILBER
BOl38Y C.SMITH,MAvoR pRo,EM
/� NORTH C A R O L I N A 28445
TODD N.THOMAS,COUNCIL MEMBER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 41112 1 s tr
64). 5}. (Name of Property Owner)
property located at 0
(Lot, Block, Ro d, etc.) '
on k r r,_ LL r+ F�- L L .,
L.(VNaterbody) I , m `�r� C . � <S/ . /;. .,fry, N.C.
(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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
I, .
i. /
•
`o Signature
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cam— 0 . 6(}c-Ce S .j rZ
Print or Type Name
Ito ZS-5- 2_ e' ?r
N t .� Telephone Number
C l4 w Date: S �, �,f/`^
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