General Permits (3719)

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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 pursuant to 45.:N•CAC Subchapter 7K :0203.
Applicant Name T fra 1:`�0 Pik°`a PhoneNumber`'O
Address i," �:j t Y A
City ") ; : r -, State N C Zip
Project Location (County, State Road, Water Body, etc.)y-Y cC, . "\,, �.,, ��� \� � of 7D,,
cJ'r.,�G' i`C`^•� �.�-. 3� 1'�r �'4 :�ii.. r -i.` Li���
Type and Dimensions of Project. ` tc
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1f-NCAC 7K..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 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 (SCALE:
- 4
Any person who proceeds with development without the con-
sent of a CAMA official under tratla
ken. assumption that the
development is exempted, will b "ion of fhe CAMA ifthere
is a subsequent determination tI w(as egyjri for7�iedevelopment.(`� ��
The applicant certifies by signi 1Q1 j.T>p�
plicant has read and will abide fay t ii.... WWW9
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
i
Applicant's signature `�-
CAMA Official's signature
Issuing date
Expiration date
• Attachmentt�-1-5--North Carolina•Administrative Code 7K .D203