General Permits (2155)

Applicant Name
Address
City
Project j ,ocatign
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_9_NCA Zubchaptew 7K-Q2Q&- f ', /�.� .5-1
_ ECG
'1 it'i� �•'�l►! �'j �rrt ;%''`i�9h Phone Number
!1/
State Road, Water Body, etc.)
State
Type and Dimensions of Project NorjJ 0?'* �f- fr
�0
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 -NQAC-7K .0203' This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Loc authori _at Qn-
Ale �;.S `f �'q 1p,7 �62'
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:
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/ 0/ I (eta%vi>
F'(r't"f ' ' r J' a l/
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-F2ra°written-statement has,beenobtained-trornadjacent '
landowners -certifying that, they"hrave­no objections AG —the
proposed work.
Applicant's sigrgat'ure ."
CAMA Off ic a's'sign ture
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203