General Permits (4143)

CERTIFICATION OF EXEMPTION
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 parsrraat$g
Applicant Name S i i 1A F / Phone Number
Address
City 1,-,A f </ iN h . State C Zip
Project Location (County, State Road, Water Body, etc.) r' e,;4,(,!" S2 /7
cc) F,D��J of i��'��Ci�/i�rz
Type and Dimensions of Project. <—T7- k r I Q f.f� C ,j'f= �� ; r7
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pm's an o-T5gTG7AG�7-K�2 a. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
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.
This certification of exemption from requiring a CAMA permit is
valid for•�s from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE: A
/'G�i; riJFjv
!
i
rim
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attac}iment:�5Ncrth Caroiina Adminisiratwe code 7K£D203