General Permits (1893)

-1r-
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 1-5-N6*al C /ter�TK.020a; _;1 ;
Applicant Name f � I fr" i ✓ Phone Number -
Address l r "e f l
City !-'!/r t s %" F,-' r State Zip
Project Location (County, State Road, Water Body, etc.) / t-2-
Type and Dimensions of Project Z/
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to- I& NC,AG-7K .0203-. This exemption to
CAMA permit requirements does'iiot 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.
j SKETCH (SCALE: I/ Ti ) j
r � ; 7
t
I 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,
Jandowners- cedifying-tfiat- they -•-have- no-'objections'lo-1he—
proposed •work.
applicants signature
CAMA `Off ici 's s nature
14111,
Issuing dat6t t /1 //,,
Attachnrrent-. 15 North Garolina-Admfnistrative Coda7K,0203_ ­