General Permits (4105)

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CER i iC-T1 ,N. '(D,F EXEMPTION
FROM REQUIRING A CAMA PERMIT C d
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 concernpursuantto l5.tJGA vbchapt9er 7K,�0298:
Applicant Name
Address Ga4V� 12- /d
City
Project Location (County, State Road, Water i3ody, etc.)
Phone Number
State 1) G zip f'S6 2
Type and Dimensions of Project ! k� a.-•v%
/ .�
/2 /X /?_ ' "/i /'", r.. terJ "s 3 ,Y r7 ` C „i�. !>✓Y-� ifYrc+tsc%
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuerat•-to140-A6'-7fF-,OM. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
46-c.
This certification of:exemption from requiring a CAMA permit is
valid for 9&"ys from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH f� (SCALE: /;,, )
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 statementhas:been.obtainedirom adjaoe-nt
landowners- certifying tha:,Ahey. have_rno, objections -to' -'the
proposed--,w rk.
Applicant-s sslge !„.
CAMA Official's signature
Issuing date
r� .r
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203