General Permits (3881)

CERTIFICATION OF EXEMPTION
1� FROM REQUIRING A CAMA PERMIT %`As -) 4. 'A
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 7K .0203.
8 I
Applicant Name v " Phone Number
Address % r
City ! f State Zip"'
Project Location (County, State Road, Water Body, etc.) ,_.
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 15 NCAC 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 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.
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 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.
FAR
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CAMA Official's signature
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Issuing date ! ) {t OCT 1 4
Expiration date LILum iiz"-i1T
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Attachment: 15 North Carolina Administrative G�o�e" W

- State of North Carolina iErr
Department of Environment,
Health and Natural Resources
Division of Coastal Management
James B. Hunt, Jr., Governor ®�Ell 19
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
DATE: J D -) Q 1996
Dear
Attached is a Certificate of Exemption From Requiring a CAMA Permit. In order to
validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy for
your files and return the blue and green signed copies to us in the enclosed, self-addressed
envelope.
Your early attention to this matter would be appreciated.
Sincerely,
s(
Field Representative
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Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #11-12-09
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