General Permits (2683)

CERTIFICATION OF EXEMPTION
, a
-� FROM REQUIRING A CAMA PERMIT ! IVOy17
2
as authorized by the State of North Carolina, 0/%
Department of Environment, Health, and Natural Resources and the Coastal Resources Cih ion
in an area of environmental concern pursuant to 15 NCAC Subchapter-74f .0203. 6 S 1 k}(S� f
3
Applicant Name `er to r 1, -.a 1'!U ru r t r.� . = A 4� I ` Phone Number(a s,>) �,S 5 - co, r
Address Po t3oie 3a��
City i ,r N s State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project ? (Jig s ' x ) o' 1e'A ;,,;
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 -NCAG 7K :0203: This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Loc1� uthorization.
iu3CSj b�iS 1
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:
til \4-
Ilk
AY ee,
mny person wnu pruGeE9Us Wlln a ucvelufnncrn Wui IUUL ulc w"-
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-obtainedfror adjacent
landowners certify ing- that --they--have -ne-•objectroTT-to the
proposed -work. --
Applicant's sign ure
CAM icial's sig re
J
z ;a
Issuing date
' -auI j
Expiration date
Attachrnent:45. North Carolina--Administratzve••6ede-,OFF ®z�63-