General Permits (3676)

-� CERTIFICATION'OF EXEMPTION
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 pursu es,;C, bshapter.�K.D2.D3,
Applicant Name :d�[issr;'w•� f.�,. Phone Numberf' .-
Address ` .04g, W 4a, r`� r',:1 k4 ,f%rg. E.
City To - X'.t f F State aye Zip �
Project Location (County, State Road, WatevBody, etc.)
Type and Dimensions of Project
ZoIUA'!%oyz,e V j rle1.w 1'st �/
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement p.ursuaa6to,.15,,NGAGz7-K402,02. 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 9,©4ays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
ISKETCH (SCALE )I
a Ile"
68 1K - 4: 0-11 690 9'- C__24_J�
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.
Applicant's signature F °
AMA Official's signatufe
Issuing date
' ? 7
Expiration datevy?-
... /99f.
Attachment: 15 North Carolina Administrative Code 7K .0203