General Permits (2169)

CERTIFICATION OF EXEMPTION
�ECE
FROM REQUIRING A CAMA PERMIT NED
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Reso rc��e�j qq
�C3UJ&Jki ion
in an area of environmental concern pursuant to # CA'C"Subdhapter 7K :0 3. AV,t ,4`3 «
Applicant Name : t %,o ,,1 a '%� r! t"F" L � "e��r Phone NDmf3 D a r�
Pp f
Address e;, ,r
City rx , r-r.•, fry ,�r-,r State �'� Zip
Project Location (County, State Road, Wa)e.r Body, etc.)
0 i �! - Yam.. ?J sf 1A r !
Type and Dimensions of Project
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 NC4 G 7K.:0203: This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other,State, Federal, or Local authori ation.
,V_'0S /1? .`�3 15_(� S_
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: )
`
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 -
Applicants signature
CAMA Official's signature
Issuing date
.'') /'%,1' AY,
Expiration date
Attachment: 15 Noah -Carolina Administrative Code 7K .0203-