General Permits (3060)

O
Applicant Name
Address
City ? p mow}
CERTIFICATION OF EX(EMPTI N °
FROM REQUIRING A CAMA PERMIT JUN 1 9 1997
as authorized by the State of North Carolina, i �...�, �1
Department of Environment, Health, and Natural Resources and the Coastal Res o?rt'rrifssiur�
in an area of environmental concern pu+strantto'l'SNC-AC"St7tsclrapter�:e2@9r
_ qs"( -_" Slk Arn .
k,_ Yetis r a'I Phone Number W-JSS� i,©D wk.
Jand Dimensions
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirementpursuartt'to"15-"NCAC7K'.=3. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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 jeV—A,,E(, (SCALE: IVvnQ__ )
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.
Expiration date(.
Attach'me—fffr'tb'Noi�Fl C rbttfia'at9ii 'is"ir�fi Ci3i 74�°0203