General Permits (2365)

�r�
CERTIFICATION OF EXEIVIPTI,
_­*Y_ /1 0 3
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal RL=
in an area of environmental concern pursuant to 15 NCAC Subchap- Am
Applicant Name Phone Number
Address 0
City 17:!, S State Ai Zip
Project Location (County, State Road, Water Body, etc.) .0144t-f- c-, 4 r,-rT
cy.- L I,,j:! A C e W i,j �! /4.4 AtiHrr4�_OFF 0 U
Type and Dimensions of Project
P 1- 4 am L Pe,
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.
7- f .�', r - ", , !_ 7
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:
A
L L
1A) A 4-4"
A4
C-,
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.
Applicant's signature
CAMA Official's signature
6-f — !7 y, -
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K.0203