General Permits (4039)

CERTIFICATION OF EXEMPTION`
FROM REQUIRING A CAMA PERMIT SUN 1 9
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resol�
in an area of environmental concern pursuant to 7FF - Stufmhapter-MZ 3.
Applicant Name ��Q�r �. �.-.0 . Phone Number H1q - Pl4t., - 7jio30
Address l`i 1
City State N'- Zip .W) kh
Project Location ('County, State Road, Water Body, tc.) a
�\ �( G,
Type and Dimensions of Project �Jcr
rs t�C. L: , f' \ 1Z
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 zNGAG=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:dayz 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: �; .; �•.� )
`�.� < • -- a;' ,r it ---
i
F�
1_
r
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
r
CAMA Official's signature
Issuing date
)\ -tsVA\� 1 c ,ri 1,
Expiration date
At,t#fi et t-155 N.arih.,Garolina-Administrative-Code 7-K--.-0203