General Permits (555)

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CERTIFICATION OF EXEMPTION =�J�
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 Aj yam,, Pea-Phone Number
Address lu, 3 r rCtcclr
City State N116 zip
Project Location (County, State Road, Wkter Body, etc..) 30�
Type and Dimensions of Project W 4, -450' 0i - A , J / k
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 g0 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.
3/ 54ul g'7
Issuing date
1l)C) �-
E pifation,date
Attachment: 15 North Carolina Administrative Code 7K .0203

01/29/02 16:46 FAX [phone] GORDON ST CC
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A Handcrafted Tradition
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406 NORTH QUEEN STREET . KINSTON. NORTH CAROLINA 29501 • TELEPHONE [phone]
252 247 1121 JAN.29'2002 15:20 RECEIVED FROM: 2525239098 #6575-002

ADJACENT RIPARIAN PRopERTY OWNER STATEMENT
I hereby certify that I own property j,;jacent to
(Name of Property Owner)
property located at L /
�-
( ,ot, -T;.oad, etc.)
on
(Waterbody) sa
rows an nty)
He has described to me as si -MlI "bel. 6, ,, the development he is proposing at that la =-
and, I have no objections to his 1,:., j
DESCRIPTION AND/O�k k `ta' . f + tip OF PROPOSED DEVELOPIM'N; ,'
(To be filed i- b, ,l proposing development)
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- ---•--------------------•----.... - ..__ __----------------.._---------- - --
Signature
Print or Type Name
Telephone Number
Date:

I l:.ereby certify that I own property adjacent to
is
(Name of Prope�6er)
property loco.ted at
onin
- — - , N.C.
(Waterboly)
(Town assci/or ounty)
ale has described to me as shown below, the development he is proposing at that location,
aci(k, no objections to his proposal.
'ISCRIPTION AND/OR DRAWING 01, 1R(Y1')ST,.b DEVELOPMENT
(To be filled in by individual pro; development)
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Signature
Print or Type Name
Telephone Number
Date: