General Permits (3878)

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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-pum •���fib. �.
Applicant Name -T-& S ETZ J W Lt Phone Number`
Address 7_OC-) _7Z L 12', -I ^' '-- -, ;
City -r-A , Z c -� E�_C:, State zip z
Project Location (County, State Road, Water Body, etc.) 11r- [2T �. r�, �Q t-yTcT
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I ype and Dimensions of Project E c 1�- 4 ' ifT_r 1,= c' n „G Pi nC r
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement ptifstmeiAG ' �^ —' 2u3. 1 his 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 9&drs from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
l SKETCH (SCALE:
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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 a
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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• P-plicant's signature '
CAMQ�D.fficial's signature's
issuing date
Expiration date
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P2 o r
Attac!i en::�5 Nort"arolina- Administrative-Sode 7K�Q3