General Permits (3235)

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CERTIFICATION OF EXEMPTION
_74
FROM REQUIRING A CAMA PERMIT,:'
­b�senauRR1zed by the State of North Carolina, �0
rqina,­
Department of Environment, Health, and Natural Resources and the Coastal Resou'rces Commission
in an area of environmental concern lliapte Wid129-3. SS7 I (k;
Alin, 'LC11k)
Applicant
'Phone Number
icant Name L F-v- Tt?- Z6
r) r) ------
.Addreii
City
State )-,J c 7
zip.
Project Location (CoUnty'
State Road, Water c e Body, t.)
. . . ^ (_):� - �-_ - 4. 7
6 )i iCz �0 -p I NL�
K I E-6 1z aA ✓�_,J
Type and Dimensions :of_ Project_ �eql N,
p e
The prop rojecttob lo at c ed and constructed as described This certification of.exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA p ermit re- valid for 99zdays from the'date of issuance. Following expiration,
uirernent pone" 19 -NaAQ_7K= 020P. This exemption to a re-examination of the project and project site may be nec
essary
CAMA permit. requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
SKETCH (SCALE:
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1, V
T2
I.
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 9 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.
eo
J
A ,Wicant's sigftli
�Impfl sign
nrara�� 1 ­7 9 (z,
Issuing date
3 1 a-01- IV 55
Expiration date