General Permits (3683)

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CERTIFICATI TIOIN
FROM REQUI RING A AJtRE�ib�lli996� / �� — E'
as authorized by the State of North C r' na, r
Department of Environment, Health, oastal Resources Commission
in an area of environmental concern 7K .0203.
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Applicant Name I Phone Number
Address
City N V-7 State L f' Zip V 61
Project Location (County, State Road, Water Body, etc.'► S " ra c
,pe and Dimensions ofProject
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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.
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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 rr. ,%,t �� f '-? ' : _ (SCALE: ,I`ll
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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.
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Applictint's signature _
CAMA Official's signature
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Issuing date
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Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

State of North Carolina
Department of Environment,
Health and Natural Resources •
Division of Coastal Management A&4
James B. Hunt, ,SecretaC "� F1
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Jonathan B. Howes, Secretary C
Roger N. Schecter, Director
DATE: 2 1996
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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,
C)rNs- n p o, �k
Field Representative
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Enclosures
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