General Permits (3728)

CERTIFICATION OF EXEMPTI r! T
FROM REQUIRING A CAMA PERMIT as authorized by the State of North Carolina, IN FEB 2 Q
Department of Environment, Health, and Natural Resources and the Coastal Re ces Commission r
in an area of environmental concern pursuant to 15-NGAC 7K,--.02034
Applicant Name _� C�in�: � 16\CNr.70r—
Address 1 � \�A
City .. _
Project Location (County,, State Road, Water Body, etc.)
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I ype ana Dimensions
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Phone Number %ci • �f r71
Zip
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90days from the date of issuance. Following expiration,
quirement pursuant to 15 4CAG 71K-�;0203: This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE:
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4
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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i lb'n 1S'�
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CAMA Official's signature
CA
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Issuing date
Expiration date
Attachment- 15 North-Carolina-Administrative-0-ode 7K-:0203