General Permits (3759)

CERTIFICATION OF EXEMPTION 9
_Y 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-15:UZ C Svbchaptex'7K .Q203,
Applicant Name rC � ' S. ._ 'r
Address
City
Project Location (County, State Road, Water
etc.)
`11�i • ll d • 1y5 �I (H�
Phone Numbers t'A
State "-<_
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to '1'5 aSfCAC 7t-.:0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip;7(,U 3, cioa t
.,
This certification of exemption from requiring a CAMA permit is
valid fo'r'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.
SKETCH (SCALE:'`'
J
1
1
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.
J
CAMA i ial's� signature
Issuing date
Expiration date
Attachment.A5.NortW--faholrn-AdmPaiStrativeCod�7K 0203