General Permits (3055)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT JUL 0 1997
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resou .
in an area of environment1.al concern pursuant to 15 NCAC Subchapter 7K .0203.---________ .
Applicant Name �'�r�..
s v1 - V (:� r\ C
�
Address l <. -
City L/\,. _ j,,.. . �-
Project Location ,(County,1 State Road, Water Body, etc_L
'i)y,t: 1,7 AFC f
Type and Dimensions of Project D
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.
Phone Number /R3 . le-f
State Zip
/11, 10,
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 Pv. i :,, Tr�,�,7` A ram•._ A c. (SCALE: A,Ve. ) I
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.
CAMA Official's signature
I �?
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203