General Permits (3757)

_ .. .... _ -z-...-.
O
9
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 1-5-NGAC-Subchapter 7K:.0203.
Applicant Name J 0,kW, �� . V_-)C S Z, Phone Number `'Jtl�,t-
Address
City _ _. \ r . _ State NY�_ zip a 0 019 h
Project Location (County, `Sltate Road, Water Body, etc.)
r)C` "Lk L'.t`(\�1C_o 4<- V•4_('
Type and Dimensions of Project QrA. O�trS L►'
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-NGAC-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 30--days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: NQN�_) I
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.
s signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Caraltna Admi►aistratf-Gadg'7f< ..0203