General Permits (4087)

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CETIF��ATIN OF EXEMPTION
FROM REQUIRING A CAMA PERMIT Cd�
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, '1's-NCRCSUirCtlapter-7K%Q203:-•
Applicant Name ( r- ­e -of
Address /Ole
City t'�3 :,, ;: /
Project Location (County, State Road, Water Body, etc`)
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Phone Number
State Zip ?Bs71
Type and Dimensions of Project 6 arl
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement purstrant-to-15�-NC-AG-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-904Z!4ys 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: A ) I
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.
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CAMA Official's signature
I- &I-97
Issuing date
1 % 3? el I
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203