General Permits (3396)

r
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, OCT G 1 �9 g
�<::5 Department of Environment, Health, and Natural Resources and the Coastal Resources ommission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K '1020a.
Applicant Name ( 'I, L -') irk LM. ,v., ie `
Address $ -al.-
City
Project Location 4CSounty, S)ateRoad, Water Body, etc.)
15:� e'�'►a..�,- r
Type and Dimensions of Project
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 c02Q 3: This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
State
f,
Phone Number�i" .- I C l
r,
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.
I SKETCH (SCALE: W J P. ) I
7P
C� � V`n i fJ S 1 iT/�.-� � �� .7�-' �' L;� % i�Y-� CU�r� 6c � U✓�, S
R—A�7 Fcc t4)
(ED" y- NC �4--Af.�
C)
� i
C)Cr .' 9i�
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.
Appiic(ants sLgn�t5rI i
CAMA icial's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K 10203