General Permits (2603)

CERTIFICATION OF EXEMPTION
_Y FROM REQUIRING A CAMA PERMIT SEP 2 g 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 Subch%§t4rATKD"q*. & ,i i+h � �, aV s' V
Applicant Name 6Le c , P, R.+. _ . , s Phone Number(TiaI6 o g'l
Address ; 4 :, ; I),,, x �r
City State L) Zip y 5
Project Location (County, State Road, Water Body, etc.) � n, P, (►.�r j1, s Old- ► L+esv
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Type and Dimensions of Project �a a... �, + r — </ I , r ! �I,y p y,.y�:.��ys�, z� a, !,,
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The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- --valid-fora0.days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC -7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
G S 1�3A-FWs NY(,)
I SKETCH (SCALE: ) I
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 obtainedfromn-adfaeerrt
-landowners certafyjng—that -they- have no" 66je6fions to tiie
proposed 'work----- --
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Applicant's sigrtiature
CAMA Official's signatu e
Issuing date
r'
Expiration date
Attach-ment: 15-,Ndffh"CaYo4na Administrative"Code 7K-.iD203—"