General Permits (391)

\ 0CERTIFICATION OF EXEMP ION
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 .02032_—'� - -
Applicant Name Phone Number
Address—1--A4
City ' > State 4" Zip
Project Location (County, State Road, Water Bod�-, etc.) r� < r:%
✓.r:i�� t�, P`'"xe, Z'/
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.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE: ) I
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.
i
re
Issuing date f, r
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADJACENT RIPARIAN PROPERTY MNER STATEMENT
4
I'hereby certify that I own property adjacent to
.� G � k�2 is property: located at
.(Name .;of.. Property. Owner
dO fl S%/t°iJ o T , . r c
�. (Lot, Block, Road,.etc.)
on iti , in Nfco UF'� J cryy)�,ij , N.C. t
(Waterbody) (Town and/or County)
He has described tome., as shown below, the development he is
proposing at that location, .and,`` have no objections to his
proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
C�4
�4d
(4
gna ure
Print or Type Name
Telephone Number

FOLEY_&
MARINE CONTRACTORS, INC.
t3021-*A Highway 70 East • New Bern, North Carolina 28560 • [phone]

... ADJACENT RIPARIAN PROPERTY OWNER STATEI1ENT.- YH-` • .
I'hereby certify that
I own property adjacent to _ -
Ego
&0 property located at
(Name of, .Property. Owner) - ;
• • (Lot,
Block, Road, .etc.) - -_ -
.0 :. Shl�s �. C.
, in C=uk,� _
°.. (Water y)
(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/ORDRAWING OF PROPOSED
(To be filled in by individual proposin
S f✓ e s 110T-19S
S gnatur

FOLEY_&
MARIN E CONTRACTORS, INC.
1902-A Highway 70 East • New Bern, North Carolina 28560 • [phone]