General Permits (4019)

CERTIFICATION OF EXEMPTION v,
FROM REQUIRING A CAMA PERMIT 4 JUN 1 9 1997
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resourceq-Gom-rwissicn-____________-
in an area of environmental concern pursuant to 15--NOAG SubeWepter—M-. ►203,
Applicant Name `�..�1, ��lx. `` Phone Number'lf'=i • -7r14 - 4 o ) 1
Address 1A 1-
City ._� . State tiL, Zipa
Project Location ((County, State Road, Water Body, etc.) , c". ofi'4 CA
L-?C��....X 1J o� i� � � `b:�w�i'� �1r. �u- �"lr' Gti- ` C"3i..r•.
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 1"CAC=7K=a3Z03. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
1�; `, Y. -' i
This certification of exemption from requiring a CAMA permit is
valid for'=:days 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:
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.
A' Ii rit's signature
CAMA Official's signatur •
J
Issuing date
Expiration date
�4,ttachnTent 1&North Carolina Administrative Code 7K .0203