General Permits (3842)

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-15 NCAC-Subchapter---7-K-l02Q3.
Applicant Name As i-1t F -/ 75 4\ss Phone Number /`GZ
Address 2� Tz ; l—
City 11 J43 0 v r ( (E State ri C Zip L ZES-E
Project Location (County, State Road, Water Body, etc.) o _ %'e-oc-
�'•�i.c-�. /�' c� BF�1 c s-7 a N �.4.�1/ / t o 2 i �c,e ,c%,,�,e �',E'L <i,4 v.�-.�
Type and Dimensions of Project+�Q
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement-pvrsuaat=tO-p5=NGAG�--7K-�Q3 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
I n._
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.
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.
f � t= u•.� r % T,��
(SCALE:
Applicant's signature
CAMA.Official's signature j
Issuing date
_ r
Expiration date
Att2f6hmont-15 North Carolina -Administrative Cade-7K-0203