General Permits (3100)

SE
-� 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
^min an area of environmental concern pursuant to Utz. s--7zlKnO203,.
Applicant Name .�� ,W �ht. t.y Phone Number�'1\4,�t
Address +•—mac:_. 1� u
City 0:•`1, State zip) 1,0
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Prgject Location tCounty, State Road, Water Body, etc.) a.* S
Type and DimensiQlns of P oject \�•` c~ <�JGCr.C+ e - r\� k ' �' a �.:� �\
b l dlf a CAS. c T 31i C G -,, 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 15-.NGAC 7K-.0203—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 9"ays.from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: �% )
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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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attach merrt:--15- North' Carolina-Administrative=Gode-71K-:0203