General Permits (2769)

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Applicant Name
Address
City
Project Location
V,
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 15 NGAC-Subohapter�K--Otes// ; ,v 4W Z#- y ?
E `— VC-61 _ 5415 Phone Number
State oad, W1at*er Body, etc.)
T IAlf'_ t '., I AIr 1 _ I
Type and Dimensions of Project - RIPIR I fimlwc- _5
State
Zip
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The pro o ed project to be located and nstructr asdegibed This certification of exemption fro requiring a CAMA p�
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 1.5-NQAG-7K-:0243. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requireme does not alleviate the necessity of to continue this certification.
your obtaining any othe State, Federal, or Local authorization.
I SKETCH (SCALE: rV / j ) I
S; Y%f+1Q'P ff"oF^
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 (�),awritten.statement-has-been-obtained-ftem-adjaeent-
landowner-&--certifying that--they--have no--objections--•to__the_..
proposed -work:
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Expiration datdat
010
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