HomeMy WebLinkAboutWorthington (4) 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 1 � w0 f 4+\In k-or, Phone Number -i l b 7—a829
Address (�-3 "fSlr,o'(P. , ..
City n',f1(is f ate It Zip C>i8'7-00
Project Location (County, State Road,Water Body, e c.) f r\ - A W
Type and Dimensions of Project Net,.) pie- P cdod ( icn t X I Ic r
Moo C'nC, P° r,rI S
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, Federa or Local authorization.
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Any person who proceeds with a development without the con- ,l?,f,,,� �(i(�/ieil/Irt?'t', r
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 Nin
is a subsequent determination that a permit was required for the
development. CAMpOfficial's signature
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The applicant certifies by signing this exemption that (1)the ap- ing date 1 1 t
plicant has read and will abide by the conditions of this exemp-
tion, � `
and(2)a written statement has been obtained from adjacent a 1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1411 F}rCri C� (AOil)u ibN 's
(Name of Propert3 Owner)
property located at C 11 PccLW' S 6(4 S J-0+ Sci
(Lot, Block, Road, etc.)
on v ii1 rci Cr .k , in O fJ,t o , N.C.
(Waterbody) (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.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT _,
(To be filled in by individual proposing development)
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Signature
David E . 66-v-e--yis .. -v\.
Print or Type Name
7/O — 3 a 7 - a 41-510
Telephone Number
Date: 3(3 O/I S
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4.11440,9*- 17 fl 1 FA : 919 972 -(117 FitEF, ..,-sPFI•I14.I.
. DJ ',.,:`ENT Rre,i,f;1•'4 N Trft(:)PERTY OWNFil STATENIENT
. '... -re b'..; -.1 fy that 7 c tql plcrty adjacent to trilf_ __, iiiibit4k iiV.%+0&J.'
(Nam of Property Ou-ner)
property loczted at CKe C3k k"ig ('; ...S hClie S Lal 5, _
(Lot, 1510 , P
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(Wuterbody) (Town sudior County)
lIe has described to me as s;:owi. t-elo the development he is proposing at that location
,:•1(f, no -,:bjections to his pre•-i,:,7,-.1.! •
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing devetoprnent)
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Signature
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Print or Type Name ''----F ,i),c-A,'-''' 00,0?,
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Telephone Number
Date: