General Permits (943)

CERTIFICATION OF EXEMPT, - -----
FROM REQUIRING A CAMA PERMIT LEI
as authorized by the State of North Carolina, ,2 0 2001
Department of Environment, Health, and Natural Resources and the Cc ast�l Resources Commiss
in an area of environmental concern pursuant to 15 NCAC Subchapter VK ,'0203. _
Applicant Name L►_ `> V;,Zi4t
Address 52 `r)
City 171 c -
Pfroject Location (County, -State Road, Water Body, etc.)
State Zip
V:_rr_I
Type and Dimensions of Project Kb.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.
SKETCH i` j I \. - ( '­� (SCALE:
too
r
.-_ ' NY'sr4 %G
Any person who proceeds with a development without the d6n- 11�_ /mow
sent of a CAMA official under the mistaken assumption that the Applicant's si
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMAcis
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.
issuing ,aate
Expiration date
11
signature
Attachment: 15 North Carolina Administrative Code 7K .0203