General Permits (3673)

1
GERTI - _ � ~uC�:N-OF EXEMPTION �
-Y �
FROM REQUIRING A CAMA PERMIT
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 paKseant to 1��RkCP Sapter �K,42A3.
Applicant Name re. e Phone Number
Address
City ; c / State Al c Zip 7i
Project Location (County, State Road, Water Body, etc.) 4 Cr' iy
Type and Dimensions of Project a
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-t.5._NCI�C,.-K;R-0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid for 00days-from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE:
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.
X /J <
It % /111
CAMA Official's signature
Issuing date
2- 3/ - 97
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203