General Permits (3665)

O
Applicant Name
Address
City
Project Location
217,11- IT 7- IF1,I)l
CERTIFICATION OF EEqMPP,,T;QW._
FROM REQUIRING A CAMA PERM
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources an7M; Co.a_stal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Es IE W
Phone Number '70q 933'11('W
Km r A Do%i S State
CountState Road, aver Body, etc.) �.� ou ni
�-fru M �, NI n+i1 e L)4 r
Type and Dimensions of Project r �f
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._
ACC
Zi
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<-':s `.:�taf'J (SCALE:-T�.:x: {)
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-writteRstatemnent•has-been-obtafned-from-aidjarcent
landowners cedifying . that - they -haver no- objectrtrrt's-IT" th
re
CAMA icial's signature
�A mvj ) C;� � ( ,-, � L�'
Issuing date
Expiration date
proposed -work,- I�S
Attachment: 15 North Carolina Administrative Code 7K .0203