General Permits (3127)

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�CERTIFICATION OF EXEMP�1 4 1996FROM REQUIRING A CAMA PERMITas authorized by the State of North Carolina, L�L
Department of Environment, Health, and Natural Resources and the Coastal F ofBff
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name f ��✓
Address i
City — .�
Project Location (County, Stat
Phone Number �7 ? — /..�5n-L7
State & c_ Zip
Road, Wate:f'Bo iy, etc.) 4s::z c-G ,K..6 r
The proposed projectto be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
SKETCH �- i ;.�. (SCALE:
ei
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n _.. _ .. �..... ,..L. .,i+h ., AmminnmonT withni it the mn-
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 ignature
cA­MA off ici 's signature
0C_/ /o /f 2
Issuing date
/s;- f/-) . /9!F2
EKOration date '
Attachment: 15 North Carolina Administrative Code 7K .0203