General Permits (3009)

-,h)
CERTIFICATION OF EXEMPTION' .� • �>
i
_Y FROM REQUIRING A CAMA PERMIT i JUN 1 9 1997r
as authorized by the State of North Carolina, I I�
Department of Environment, Health, and Natural Resources and the Coastal Resoul§,_& il+s ion — f in an area of environmental concern pursuant to ISN CAC Subchapter-71<-.;0203.----------- '
Applicant Name -i'�t �� �. � ��,c1 QI-- Phone Number �1��i • �`� ; • `i` �;`1
Address_ i-,)� �.. .
City r f- State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of. Project `���� �� ��c.,;: �h�� - � ��C c i, U�: '� i �,. A V
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1-5-UCAC 7K-.-.0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
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 obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
This certification of exemption from requiring a CAMA permit is
valid for grays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE:
i
f
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
vAttachFnent: 15 North Carolina'Administrative Code 7K .0203