General Permits (3607)

r, CERTIFICATIONIN
fg�Wl
_Y FROM REQUIRING A CAP9 T9 10
as authorized by the State of North CaroDepartment of Environment, Health, and s r
in an area of environmental concern pursu.1"MTTTW�l.'S ac o%
Applicant N�me �'' '" .') -- 1 fo r
Addres r r i r -�- �% ,- i .y, -I y
City _F / State
Project Locatirgn (county, State Road, Water Bod , etc.)
"IT ION
*ia I Resources Commission
0203.
Phone Number
l zip.�
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Type and Dimensions of Project /e r{' l' �' a'� ` 1 r ' ,� / J. x
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The proposed.project to a located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the 1.CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
SKETCH { Cv� �'' % %1 (SCALE: )
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Any person who proceeds with a development without the co.Q-
AP"
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
Appl ant's g ature
is a subsequent determination that a permit was required for the
CAMA Official's
development.
signature
The applicant certifies by signing this exemption that (1) the ap-
Issuing date
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 Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203

State of North Carolina
Department of Environment,7
Health and Natural Resources 4 •
Division of Coastal Management
James B. Hunt, Jr„ Governor �
Jonathan B. Howes, Secretary FC
Roger N. Schecter, Director
DATE: 1996
� as 1s\ . \A CM uy��- -bR..
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,
Cam . p;�Q
Field Representative'
epresentative �I
/dh
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #11-12-09
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