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General Permits (3184)
�O Applicant N e Address 4 City L -1 Project Location 1- 1) ' / /i r, ( _ CERTIFICATION OF EXEMPTION P1 FROM REQUIRING A CAMA PERMITS v C� as authorized by the State of North Carolina, Department of Environment, Health, and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203. ? Phone Number/JG 7 G ,- f,` I- 'olffnty, State Road, Water Body, etc.) State " r' Zip W _/ d ! 5, v d -f (1 L4 g,,;` -7 ( Type and Dimensions of Project -1 /c _r r f < A _C =c. 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. L-/ryry 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 (SCALE: ) c�°a � o ®�Ll ti0��� a© C 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. a *plicant's signature- CAMA Official's signature Issuing date -�,_ -3/_ g17 Expiration date Attachment: 15 North Carolina Administrative Code 7K .0203 F - State of North Carolina Department of Environment, I?F Health and Natural Resources • • Division of Coastal Management James B. Hunt, Jr„ Governor Q E H N F� Jonathan B. Howes, Secretary Roger N. Schecter, Director DATE: 1996 1 0 W__ j 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, (I. Field Represen e /dh Enclosures P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #11-12-09 Telephone 919-72&7021 FAX 919-247-3330 An Equcl Opportunity Affirmative Action Employer 50% recycled/ I Cr% post -consumer paper