General Permits (3197)

-� CERTIFICATION OF EEMPTJON
FROM REQUIRING A CAMA PERMIT,'.
as authorized by the State of North Carolina, 0 � �' 1�
Department of Environment, Health, and Natural Resour nd the Coastal Resourc ommission
in an area of environmental concern pursuant to 15 NCA
Applicant Name �k)�% T ►C % _ h6_ff _Num er
Address O (�
City "DV-r e
Project Location (County, State Road, Water Bodyy etc.)
Type and Dimensions of Project 4.:tr.ti+n -
_TvNSA %,,,11 sv� r_4 c�i 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 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip
1-4-h
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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: ,. i )
6,5' L- )T
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.
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�OpiN(;`r,tit
Applicant's signature
CAMA Q� I's signature I
j C-•L.J o� �i 1 � `1 �D
Issuing date ��7 19ci /
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203