General Permits (3727)

O
CERTIFICATION OF EXEMPTIC
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resourc,
in an area of environmental concern pursuarrt4o-95 NCAGSubehapter-7K :0203. �r.�•�,,.,,.®��aa�aarqaww"
Applicant Name L`11rir? Phone Number L//%%i'15�
Address
City State ivy- Zip %c,
Project Location (County, State Road, Water Body, etc.) ���� �. r` Vic+ . r�,� _ �ii' / 7 5 - i t
Type and Dimensions of Project r
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.
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.
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SKETCH (SCALE: J;;• )
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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.
Applicant's signature
AMA Off icial's'sigfiature
Issuing date
Expiration date
Attachment:) 5 North Carolina-AdKtMtrative--bode-4PCZ=3