General Permits (3979)

.lei 5_ 24 9
6ERTIFICATION OF EXEMPTI
,--Y
FROM REQUIRING A CAMA PERMIT ;i
as authorized by the State of North Carolina, FEB 2 0 1997
Department of Environment, Health, and Natural Resources and the Coastal R mmission
in an area of environmental concern pursuant te^15 id�A Sebofaapter 7fF°:6
Applicant Name 1 '_ J41 l_ Phone Number"
Address Z&O C.sJ-"r ? wct0 0 17C
City f7 r c s �- State NC Zip _
Project Location (County, State Road, Water Body, etc.)
R o .a > <7 /? r �K_ ivy '�7 �� -6T �/i v ra _J
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 pursuan�to,1,5-hfOAC 7KF 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 gaD*.s 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: ,V0A1,,e- )
I i
fAp
(
i
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.
Applicant's signature
DAMN/ '0 fcial's,sfgnature'_
Issuing date
Expiration date
•r ��C- •.nm 1-YI -W L- - • - •, i