General Permits (3177)

CERTIFICATIO TION
�Y-JUL ��
FROM REQUIRING A C PERM1
as authorized by the State of North Car
Department of Environment, Health, and%W1*PWOAOMMLST an -t-ie Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
Address 177 &n ,1 ,
City 1 ✓J v- ' State Zip =r`
Projec ocation (County, State Road, Watgr Body, etc.) •.n J'
Type and Dimensions of Project 1 !ar
119
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.
This certification of exemption from requiring a LAMA 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 t" �7 O (SCALE: )
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 sig Lure 1 ��
L, - (� .
CAMA Official's signature
-7
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

State of North Carolina 'T
' Department of Environment, LTNWA
Health and Natural Resources • •
Division of Coastal Management
James B. Hunt, Jr„ Governor p E H N R
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
DATE:1996
Attached is a Certificate of Exemption From Requiring a CAMA Permit. In order to
validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy and
the attached regulation (7K .0203) for your files and return the blue and green signed copies to
us in the enclosed, self-addressed envelope.
Your early attention to this matter would be appreciated.
Sincerely,
Z�' P i
Field Representative
/dh
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #11-12-09
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