General Permits (4100)

4� CERTIFICATION OF EXEMPTION�j
,..� 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 pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name , ice 1 Phone Number 919 2 y)
Address A-
City !'F . 7F ! State Zip � Sio
Project Location (County, State Road, Water Body, etc.)
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Type and DimensionsofProject ez, 3 'A- 8
The proposed project to be located and constructed as described
This certification of exemption from requiring a CAMA permit is
Obove is hereby certified as exempt from the CAMA permit re-
valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to
a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of
to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE: , , , . ) I
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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
L -c X, 1
CAMA Official's sigrrature (91 HID .77
VC. A.
i {
Issuing date (,{}+ 1 4 f 111
Expiration date jJLbjJ
Attachment: 15 North Carolina Administrative Code 7K .0~ 2 T

State of North Carolina
DADartment of Environment,
Health and Natural Resources
Division of Coastal Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
-z "%< /"
/ wc- � ,. 7i
Dear
EDEHNR
DATE: iron 5/ . 1996
Attached is a Certificate of Exemption From Requiring a CAMA Permit. In order to
validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy for
your files and return the blue and green signed copies to us in the enclosed, self-addressed
envelope.
Your early attention to this matter would be appreciated.
Sincerely,
Field Representative
/dh
Enclosures
AW
P.O. Box 769, 3441 Arendell St., Morehead City NC 28557 N%'w4
& FC An Equal Opportunity / Affirmative Action Employer
Voice 919-726-7021 FAX [phone] Courler l l-12-09 50% recycled / 10% post -consumer paper