General Permits (4080)

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CERTIFICATION OF EXEMPTI
�:- T77
FROM REQUIRING A CAMA PERMITI JUN 1 9 1997
as authorized by the State of North Carolina, - U�'�
Department of Environment, Health, and Natural Resources and the Coastal Re sl n ._..,•.._e
in an area of environmental concern pursuant to-46-14GAB-Subehapter
Applicant Name r d tzt;% .l 17b i:'c % /'v : j k-' k Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project.r;r
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to'1s`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
...L..... ,.,.'1;+k n A^,,^I^ mcnt withni it tho nnn- . i( -f _ f - •-"'�.� �.- -
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.
Applicantsignature
-'t, ) �X\ Q,,��
CAMA Official's signature
1q `i'`
Issuing date
Expiration date
At[ach'ment'-1'5-North'-Ca'roiirra Adrrrinistrative Code-7K•.-0203