General Permits (524)

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
Address
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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.
State
� "3
Phone Numbers % ( -_� c±
zip 1
This cc-tification 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: )
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 j
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ADjACENT RIlARIAN PROPERTY OWN= STATEMENT
I bereby fY th u I own Property adjacw to 66s I Ltv- da v; 03
property low"d at ko r dfl, d0C-s fo_TL* 7ot, blmk, road, etc.) on
i
d � � 3 0 ,�• D (watwtbdy) in the Town of Morehead City, North
C4MUM, He/S�A its described to me as shown below the davdopmect balms is proposing at
i
that looslon sd I have no obje ons to this PropoW.
won sr.dlor drawer of proposed d"opment; (►o be Md in by ind dull.
Ps'op development)
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Aev r D

ak
ADJACENT RIPARIAN "YY 9 VNXR ST'ATZMMNT
I bosomy that I own property a4aaeat to _ Wu. / ter- ®.e v; s is
i
pat L d 9' YA 84-aCK 101CZ1# 7 swe mj2) aot, black, road, etc.) on
fie 0. k a s cp k N o (water body) is the Town Of Morehead City, North
Camlim. HeAhe hu described to mo as shown below the develops n& helehe is proposiqg at
that loeatioa and I have no ob}eations to this pmpouL
r3J S o
Sou A
Pa.vovo;i1D
!rx 7' ft*o t 6.
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Num
%Z2 �173q
Phom Number
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MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PERMITTEE' S NAME: I
LOCATION:
PERMIT #
�r
FIELD REP
f�
PHONE: q,
DATE REPORTEDLY COMPLETE: (—
DATE OF INSPECTION J O
1) Dot ured dimensions of the development differ from those indicated in the permit and workplat?
Y NO [c' cle one].
COMMENT:
2) SEDIMENTATI &EROSION CONTROL:
disturbed areas Y /NO [circle one]
COMMENT:
Has Permittee seeded, grassed, or otherwise stabilized all
3) FUTURE MOMTORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? YES [circle one].
COMMENT: