General Permits (498)

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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 (DOW11 ee ii Phone Number qll-dab - 23
Address
City State tell Zip Z ;76/J
e Project Location (County, State Road, Water Body, etc.) CP?+yr,N (21�1 -it. 4 f,
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Type and Dimensions of Project `'PAVfr=i� 1fC kL vz N(Ps dC l-v.'�''
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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.
SKETCH
Your project is subject to the North Carolina Division
of Water Quality Neuse River Buffer Rules due to its
locatior, within the Neuse River Basin.
Please contact Deborah Sawyer or Tom Steffens
by phone [phone] or via a -mail
Deborah.Sary ernncmail.net or
Tom.Stcffens r, nemaiI-net.
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.
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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
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.
Applicant's signature' • _,
CAMA Official's signature
%-
Issuing date
Expiration date
i Attachment: 15 North Carolina Administrative Code 7K .0203

7 FEE-18-02 MON 13:43 BETHLEHEM BAPTIST CHURCH 266 6221
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FEE-18-02 MON 13:43 BETHLEHEM BAPTIST CHURCH 266 6229 P.02
I hereby certify that I own property adjacent to J�� [�) I �EZ1;i'1171
(Name of Property Owner)
Property located at SM ! TN Y'D1 16 A b ,
(Lot, Block, Road, etc.)
on CL0 S Pi�oT CREc-K /N.Unr_ R�Ltin PA 114�4' ock< r &AVCjI C��e n1T/) , N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the develapmen,t he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPM —NT
(To be ftlled in by individual proposing development)
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Print or Type Name
Telephone Number
Date: -�'Z- , C

FEE-18-02 MON 13:44 BETHLEHEM BAPTIST CHURCH 266 6229 P.03
I hereby certify that I own property adjacent to JNy k o '-t DR s
(Name of Property Owner)
property Iocated at sm i -rN f� m T d A D ,
/ (Lot, Block, Road, etc.)
C
on L0 6 FbT CREc-K%IVGVS G iz IM I k.ock r&AV-�SC 2�-r,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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPM —NT
(To be filled in by individual proposing development)
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Print or Type Name r
'336 '-3�i-466 i asa -11-9°9-ou'4'- S
Telephone Number
Date: Z - y ram—