General Permits (2098)

CERTIFICATION OF EXEMPTION IZEp ED
_Y FROM REQUIRING A CAMA PERMIT AUG 13 2012
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources CofiCITY
in an area%�o�f� environmental concern pursuant to 15 NC/A20
�C Subchapter 7K .03.
Applicant Namer�'� de ���� i ,!rt�' ��*°� Phone Number
Address
City State !Z�ip 4
Project Location (County,:S�te Road, Water Body, etc.) ./c° u�
Type and Dimensions of Project 64y e �Z -" —7 ►y.,V�,-9�'
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 (SCALE: 1/4 )
,� lip✓l'✓ t:� /4-/i� � �� 11 11r,
� ire
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. fL n i
Applicant's,igna re
CAMA Official's signature
Issuing da e
�/�� rCz
Expiration date
Attachment: 15 North Carolina Administrative Code 7K d03
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