General Permits (795)

-Y
CERTIFICATION OF EXEMPT
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal
in an area of environmental concergpursyant to 1�ubchapter 7K .0
Applicant Name ( P
Address /1,0
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project /)<,;, ri IS
11
JAN 2 2 2001
Nv`r //?! kk`Yc-4o 1Phone Number U
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 Zip c" 1
.4 — i -A-4 e . , ., , l . , 1 / V i
/3C(6 Iry
This certification of exemption from requ ring a -CAVA permit s
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.
I SKETCH j, /i (SCALE: ) I
iV11,121iml,44 I�L?i i ti
Tr<<el
� ►L 1.t d'
t4
r
Ii ff - L I 1 • \�7
7-b ,f. IJCYILI�
i
l� � I
iAj
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.
V,
Applicant's signature
CAMA Official's signature
Issuing date
_.pia 4 / . /V , Zc I
Expiration date
O SG-a6 //It:
/1414
I)el
M
Si? A',) lA-<
),Is_ el _ f20-k
Attachment: 15 North Carolina Administrative Code 7K .0203