General Permits (4066)

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CERTIFI-CAT1O•N70F EXEMPTION
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 pursuac-ta aC-Sbibthapter 7K• 0203.-
Applicant Name 6i,,,va ' e,- Phone Number '7?rf-671/
Address P-2 7 e6-- S' .
City _jjw�n, - State - Zip /s
Project Location ( ounty, State Road, Water Body, etc.) /
Type and Dimensions of Project ;�✓a
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant4e=#sNCACr'7K""'OM-. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
,4ri - �" /
I SKETCH
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.statemef*has-been-obta'rryet from-adjaeent
landowners- •e-ttfying that they'=have--no-objections--to-the
proposed —work.
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This 4,tifi�ration of exemption from requiring a CAMA permit is
valid fXG-d-ays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
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(SCALE: M,7x )
r-7 l C r_. ,t
Applicant's signature
_r4 ;.r-6/ % J%, �/
CAMA Official's signa re
,r-2-94
Issuing date
7- P97
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203