General Permits (2160)

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CERTIFICATION OF EXEMPTI0N ��-
FROM REQUIRING A CAMA PERMIT SEP 15 2011
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 15 NCAC Subchapter 71�Wi2fn CITY
Applicant NamePhone Numbers `
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Ai 7k� Akq&46"f71-fc '�; -m40
Type and Dimensions of Project 14 _W 4, 41 :�4-1 4 .v
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R4 A_;/} '/! i S /6 CI ski
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.
SKETCH Pi ; (-W i "
This certification of exemption from requiring a CAMA permit is
valid forgo dales from-thedate-of-issuance. Following expiration'
a re-examination of the project and project site may be necessary
to continue this certification.
a* TC JPi t AA.4--01 C. C _' `.G11., V )
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(SCALE: )
i�ept�t,�
ir-
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's didnal"ure
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
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 t2T'a written statem-ent'hasbeen obtained from adjacent A.
landowners certifying that they have no objections to the
proposed work.
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Issuing date
/ -Z.
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203