General Permits (3963)

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CERTIFICATION OF EXEM
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, ,.,..,,---------------
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Department of Environment, Health, and Natural Resources and the Coastal Resources Commissio
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name ('c rl�i.n =1 C�3xfz f3atzn 6", Phone Number 7y J - 4 / -77
Address - is A �c 4
City i L �.-j i M,-, `rc "k t State rl C._ Zip Z e- �
Project Location (County, State Road, Water Body, etc.) I%kJ Yz ti re -AS I AL. XAJ/1. L,1 vA/APIk n
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Type and Dimensions of Project b p L.A r c 0 d e - Xi' tt AICa I "Vel e,
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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 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.
I SKETCH j --J le-KI / L TT 5 Z
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.
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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,
CAMA Official's signature
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Issuing ate
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Expiration dhte
Z?- 1
Attachment: 15 North Carolina Administrative Code 7K .0203