General Permits (3980)

CERTIFICATION OF EXEMPTIO
�- FROM REQUIRING A CAMA PERMIT
AP 0 1g97
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Reso
ommission
in an area of environmental concern pursuant to Y5'NC'AC Subbh5J0fer"7f� v203.
go~""M"9'"f `
Applicant Name C. ��ww, _,'� , °ate ,, t 5�,4 _... ,, ,.... F4Q ;eu<� 1. Nlv, '= Phone Number i1'1- v
Address
City '. `t ..,C.�.._.. - , . State Nr,-
zip .;a Vi I
Project Location (County, State Road, Water Body, etc.) 6g,a.A \ C:,� g,4 t. � j i I2�
Type and Dimensions of Project f� V&,
ILL•^ ;v , i
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 16-N0AC -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 904ays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: ) I
s
v
3
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;"
CAMA Official's signature
Issuing date
Expiration date
Attaehment--1'5`North-GeibfhTr t-A,dttsinistrative Code 7K .0203