General Permits (2210)

CERTIFICATION OF EXE PTIO sk,
1 ,
FROM REQUIRING A CAMA PERMIT P`/ _ �6� R '`J`�1�
as authorized by the State of North Carolina, { m�onJ
Department of Environment, Health, and Natural Resources and the Coastal Rese4 wm
in an area of environmental concern ursuant to 15 NCAC Subchapter 7K .0203r -- """"'
Applicant Name 11,e ti �� �- vJ Phone Number' (O s� q SI 71
Address
City State N c- Zip It
Project Location (County, State R0 , Water fty, etc) -_3Nr(Mno nt c , &A -A A A3.0 h c�
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 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
42/
An
y 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.
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.
(SCALE: I 1­ 90 va�
MD
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11111�`ti'�
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Applicant's s
CAMA Official's signature I
Issuing date,
b & L4 Lc,
Expiration date
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Attachment: 15 North Carolina Administrative Code 7K .0203