General Permits (2895)

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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 NCAC Subchapter 7K .0203.
Applicant Name r'r? .o t �i7L r �2t ,: PhonP Niimher //i! i Z %CI
Address '
City
Project Location (County, State Road, Water Body, etc.) `i'I.L)
Type and Dimensions of Project
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.
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.
State
Zips:
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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.
c_
CAMA Official's signature ! c) e A 3 t'/, / S •,,�
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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North Carolina Department of Environment and Natural Resources
Division of Coll W iNer�lpelnsnt
Whael F< EaMey, Govmor -JImos K Ompon: Dt edw
Authorized Agent Consent Agreement
VAW G Roes Jr-, $=a
is hereby authorized to act on "my behalf
in order to obtain any CAMA permit(s) required for thG property 1W,0d below, The authorization is limited to th,
specific activities described in the attached sketch_
LOCATION OF PROJECT:
PROPERTY OWNER MAIUNG ADDRESS:
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6 Z PHONE NO. X3�'" �® 7 4'
AUTHORIZED AGENT MAIUNG ADDRESS.
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Signature of Property Owner.
Signature of Authorized Apen
Owe;
PHONE NO, 7i 7 % Z
127 Codinel No Edo.. WMWO B. M Mt Came M05,W5
Phone 910.79&72151 FAX 910 3* I JnMmet www namaedrnanepwwl net
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