General Permits (508)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT 44
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.
a� Sys_ 5 fit?
Applicant Name 7fPcLt.-•. 11�('n5 L�e (� Phone Number (ciff)'45 - 5,114/a.
Address < -? -1 e 11 ',arc, r•I l d
City -ems- State Zips
Project Location (County, State Road. Water Body, etc.) ?� e , ��-; . ,,, r�'1 <c r c" Y
Type and Dimensions of Project or: An r ft)Oce e— _ S "y Sr, ' ., e* ,1�� � a �'�r) v'
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.
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: ) I
L i� C 44t r C r
j
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.
CAMA Official§ signature
Issuing date)
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

919938GI87 p.3
zi--Jace.-j: tc � t(A v. ay!a I- JJA- I I , I s
(tijrne of Property Owner)
PrOpe—v locz�?d at
(Lot, Block. Road, eic.)
7 C�
on Mc -
a
(iVaterbody) (To%a=zndP8r-Countv)
H- hias described to rre as shown below, the deve'opment he is proposing at, that location,
, - I I .—-i'
-!- d' T 'r �lv no 00,Do,-)
ons to his prcsLi.
DESCRIPTION AND11OR DRAW OF PROPOSED DEVELOPMENT
(To be filled in by individual pro Pusin-- deve.opment)
Si_—acure
Pr:n: or Tyve Narrie
s
___
ie:ejhohe Number
Dar--:
.

j J�JHG i 87
P. 5
(Name of Property Owner)
°M� erry lwttzd at
-A
(Lot, Block, Road. etc.)
Yfc o ff`
CW--terbodv) (Town and."or County)
He '112-s �o mz: as shover.. bellow, the deve7cp�—,.zm he is proposing at that lcca-L.:on,
s pronosal.
ill'—SCRIPTION AIND/OR DRAWING 01. PROPOSED DEVELOPMENT
(To be filled in by proocs4ng development)
T vne Name
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