General Permits (1968)

Applicant Name
Address
City
RECEIVED
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT I AUG U 2 2011
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal ResourcR y�
in an area of environmental concer pursu t to...15-NCA6.6ubchapter- 7Ki�
J
r� Phone Number+J
i
Pf
Project oc ♦iojjj[�j (Co(ulitty, S{
Lfl{f,✓ I \ iC
Road, Water Body, etc.)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to .t.5:N,jC,,AC:°7K ---020 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other Late, Federal, or Local authorization.
IAIC 1;< 1 1? ,4!D 3 </
State
f01.
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.
I SKETCH (SCALE: IV I ) I
41r ,
f
111 Ile //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 writtOn-statement has-been-obt'ained,f ram -adjacent•-.._.
la'ndownefs-eertifying--0; .they have_ no-objectioMl- t-o" the- ,.,
proposed- work:..
Applicant's sign Itur' "
CAMA Off icial's`signatu e
, r7;
Issuing date
41111121,, j
Expiration date
Attachment:-15.North,Garofina Administrative G©dPe 7,K '0203­