General Permits (4011)

O
Applicant Name _
Address
City
Proegt Location
CERTIFICATION OF EXEMPTION 4-i2 R P-'
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 pursuant to 15 NCAC Subchapter 7K .0203.
i (w��,
! fi t. C� { ( � ! � t ' G L-v­j ; Phone Number W � � S j — �c`� 3 f
State Road, Water Body, etc.)
Zip
Type_and Dimensions of Project T,:i IL t_. k C �- - Pt? C-CK7 Tir) 14c ' c IC 41 Al
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: )
I ;,� ` r of �► l`�r �''� Gc �d C_�-T`�� _,
_L S/2p
--
�V
r
iLk---
t'4
t
A I i nnrc n ­hn nrnroerie with n Anvelnnmunt without the mn-
sent of a CAMA official under the mist k aestLmpi oaf ppAcant's signature
development is exempted, will be in vi n of the CAMA if there
is a subsequent determination that a q�e was required for the
J L ; AMA Official's signature
development. AUG 1 4 1997
The applicant certifies by signing this exempts ,#Iig Issuing date
PIlcant has read and will abide b tl1 � Iof tA. ENT
on, and (2) a written statement has beenn`01a�inneed fr m adjacent ��
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203