General Permits (3026)

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f I-��lrtr�c nos � �a 7�12/`/6 /►-ttori�rz,rAxe1�-
y CERTIFICATION �OF "EMP:TION ;.
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FRQMREQUIRING AFCAMA`-PERMIT t
,t• ��r:,l-"�.,as_author�zed by the State of North Carolina �.�,:3, �F -- - , � __ Y "
.'•,� � T.. A4W -i'- .. 1 . '� 1�-`_ _ T .r,. ,\.
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission .
_ � . in an area of environmental concern � " ':
Address` RT-41 3 Jx yl t1{ = L k F r s, Phone Numberz �iq�923 3Lb
City t3A� r. 1State r\IL Zip Z'7�v
Pro)ect Locafion (County, State Road, 'Water
etc.)3Fc�Uorz v► >^ko,�T` { hf
C x t E IC r t TU'n1►1 Cif i' i�a ;^a':
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e and Di ons of
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-._ xtit-'Ji•A rf rf dir.i'fa ` '•i4. i •� $: 3 - t ��-rt� f,nf:..-irosa . ...., JU
y _r The propo ed project toabe located and constructed as described f� This certif!cation of exemption from requmng a CAMA permits''
above is hereby certified as exempt from the CAMA ermit re ' valid for c .ten, P �r 9tgs from the date of issuance. Followin expiration,z
uirement g 9 P This exemption jo ' a re=examination of the project and protect site may be necessary
CAMA permit requirements does "not alleviate the necessity of to continue this certification.rs i
your obtaining any other State Federal, or Local authorization
SKETCH
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evelopme
Any person who proceeds with a'dnt without the con
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sent of a CAMA official under the mistaken assumption that the
.
` `Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a determination
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subsequent that a permit was required for the-+'
c. -•
--�-�siczlu`re�_
development.
CAW4 Official'
The applicant certffies by signing this exemption that (1) the ap-
I 1 `- z G Q ) C1S
plicant has read and will abide by the conditions of this exemp-
Issuing date
tion, and (2) a written statement has been obtained from adjacent
_z-; i IL`/ j 1�-j -3
landowners certifying that they have no objections to the
Expiration date
proposed work.
Attacfin5�r :-�S.No�th Caro riia-Administrativ�'vde3