General Permits (3672)

Applicant Name
Address
City
Project Location
CERTIFI,CAT GN::,OF EXEMPTION
FROM REQUIRING A CAMA PERMIT /Vk
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant•to-45- NCAG•Subchapter 7K .0203.
Phone Number
nty, State Road, Water Body, etc.)
Type and Dimensions of Project i°ii pn. 170 °
6111 A I r .11
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pur-scant_.to-45-NCAG 7K 0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
State ,v C. zip 211S 7v
2 r..:
This ce- tification 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:
. AV ilr,/
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 writtenstatement has been obtained from adjaceh-t
landowners certifying -that they. have no objections- to -the
proposed work.
I
X"1, fi/rW(tv)i
pk�_, A 11-
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203