General Permits (3733)

Applicant Name .
Address
i
City , 'J" ;
Project Location I
CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT APR \0 1997 '1
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Reso i
in an area of environmental concern pursuant.to.15 NCAC Subchapter 7K .0203. ��'�'•"•'a*w141►
i 114,4
1cn Phone Number
State Road,, Water Body, etc.)
Type and Dimensions of Project 7
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.
State r'`
Zip g
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: d
= r�
� I � r ,fs
_ 7-.._---
..�
1
Xuhn ^rn nrlc with n rlavalnnmant withni it tha mn-
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
CAMA Official's signature i
3ir- y
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

ApplicanLName
Address
City
Project Location
CERTIFICATION OF EXEMPTI ,
FROM REQUIRING A CAMA PERMIT APR 1 1997
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Res ionM
in an area of environmental concern pursuant to t5.NCAO-SubchapteT K-:02D3...��
1 s,ri. �'`Zc►a�� �Q Phone Numbercllc, =tb�+ L►1`1`1
o� 3� (
, State Road, Water Body, etc.)
State
Type and Dimensions of Project S�nm c 7,,"-o.e - r— c 2S 5>.�_��
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to'I'S-=-AC_7W-:.-0-2D3. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip
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?., )
Ile
I
Cprw�
t �a
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
CAMA Official's signature
_i i,N\ate. \�(VA
Issuing date
Expiration date
Attach m ealLI5-NG4h-Getratin' a A-dm i n rfstrative-Go4e-71( 0203