General Permits (4139)

CERTIFICATION OF EXEMPTIO fu` C 0 low 3
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, ;];Ld
Department of Environment, Health, and Natural Resources and the Coastal
in an area of environmental concern pursuant to-15 NGAC- Subchaptax=7K .0203.
Applicant Name % ,QVI G Or siz0cco,E its I t'l1,Qr1Gk, s Phone Number (qlr .) 913 1S_6
Address ` % 9d 4c K (?Ds y/kky
City State /-k-- Zip
Project Location (County, State Road, Water Body, etc.) kF-Autfvi?f c, oer Jx i 331 .a r
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Type and Dimensions of Project K i't . c F 12 ' x .3 2 ' 1-yf-Aj2 �?'� ; , or Y � x —,--
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAG-71K_0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
CC
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.
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Ant nnrcnn luhn nrnnaarle with a rlavalnnmant withnut the rnn-
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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Applicant's signature
`�AN� ici I's sig urea' i
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Issuing date
�=�/ 1,7ky fy7r
Expiration date
Attachment:-15 North Carolina Administrative Code-7K .'0203