General Permits (3792)

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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 toltACtiarpYe�;.EZ2A3.
Applicant Name rG.�
Address `A ti u
City ._ -) ." "r-
Project Location (County
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Phone Number l)l`� - �31-�b�OtlCj
Type and Dimensions_ of Project C, CA:.r 5' 4
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant 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 forVadays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH —y F , (SCALE:�V p y )
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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.
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Applicant's signature
CALTA Official's signature
Issuing date
Expiration date
--•Attactrment:_ifs-North•Caroiitta'Ad:ministrative-Eode 7K :0203