General Permits (613)

L1t i'_V Co
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, s
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 Phone Number
Address
City State Zip J y i
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.
This c^rtification 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.
SKETCH (SCALE:
k Of
iL1:-kt.
V- L
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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

NOU-03-1999 17:14 FROM DCM MOREHEAD 919 247 3330 TO 2400770 F.02
A JA(;ENT RIPARIAN pRopERTY OWNF:R STATE-' IIN-'T
Jkne-6
MI _5
f-'wmrf
I hereby certify that I own property adjacent to -_ic>kn Mp( CLA C V11 A'S
Name of Property Owner)
property located at LOT 23 f3i aCkb�'a o Dr. Oucc q 4eet-
(Lot, Bloch, Road, etc.) '
on %.5/Y) 9 rlf C65 /'C in P4M L' I CO
' , N. C.
(Waterbody) ('own and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have nc 'objections to his proposal.
DFSCRIMON A.NI D/OR DRAWP G OF PROPOSM DEVEL0PTYffN-T
(To be filled in by inditi&ual proposin-development)
Cx 7'L'N1) Pt ipMP
ro PR0725- CT LA goo
rinG 1V G"-Rose
51�oR� 1--1 V
I C-,�rlSTiN� RIPRAP
i lc a
�DRa�r�Nc� .s Aei TcI 5cAci)----,�� ---
Cxl�r�nr� R�PR�P
PRc��'y
DEC 14 1998
tore
_ 1114iftc-73 �r
Print or Type Name
(252)2 q5� o �1, 9
Tel phone Number
Date: — /_ R 7
TOTAL P.02

ADJACENT RIPARIAN PROPERTY ow ER STATEMENT
I hereby certify that I own property adjacent to JD;-; N Mc, Ar\) SNt , rif 's
(Name of Property Owner)
( t3,a�K b fir- , ve)
property located at 4- oT 2.3 J3 '-c�- P1 e-e ,r g Sv t S i Ofd,
(Lot, Block, Road, etc.)
on T 14 C 5 E K-
(Waterbody)
in Ft-,, m L , c:o C, i N.C.
(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 DEVELOPMENT
(To be filled in by individual proposing development)
SigJ12�
n NCO)
Print or Type Name
Z�Z �' G�5'Z_
Telephone Number
Date:
3NoL) q0

ADJACENT Rr-PARiAN PRoPERTy owNER sTATOmA
I hereby certify that I own property adjacent to ,wy Vl/�C) �Af\3 "ro L T-i 's
(Name of Property Owner)
property locatedat �-C'r 23
(Lot, Block, Road, etc.)
on Hof —r, C� t 1 < — t��r a'1/l i'l co 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 DEVELOPMENT
(To be filled in by individual proposing development)
pP672 T T 9 ?W0T 5,T
I�
7- 2-
�X�Pd15roy?
1.oT Z3
Signature
Print or Type Name
Telephone Number
Date: l /4j 2