General Permits (2488)

O
Applicant Name
Address
City ;? !?-
Project Locatior
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 1-5-NOr4GSwbebapter 7K--e2D97- 11- Off✓ 21VP ll7?
State Road, Wate
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 5, NCAG-�K .0203: This exemption to
CAMA permit require is does not alleviate the necessity of
your obtaining any, huer State, Federal, or Local author'zation.
�79
Phone Number fffly 6V
1.0
State VF Zip
L V !✓a � rJe�
This certification of exemption from requiring a AMA 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: )
L n)7-J C 1
®C4!�--RV
5)9/VV BP
�"Of per ( �' .1 1 oval
?
pr- K
�
VIC-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 obtatwd fromd j cent
Jandowner-s---eertifying---that--they=:.harre- no - objections-tc-the,
4--prepeeed-work:
{
Appli6ant's sign6tvre
Expiration date`
l
IN
Attaef-iment,� 4-6 Adrr�'