General Permits (4178)

v CERTIFICATION OF EXEMPTION --
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, t
Department of Environment, Health, and Natural Resources and the Coastal Re�gp�Q
in an area of environmental concern pursuantto-15 NCAfrSabchapter-7K=-.G203. �s
Applicant Name
Address Jai
City A.0 '
Project Location
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State
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Zip �. -s -
Type and Dimensions of Project .S7`t�rn c,>�7s�z;�c� c — 'E'.r,/ e �'` 1L ;e 0V e'r
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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 -IS NCAG-7K :0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
:IBC
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.
SKETCH (SCALE: /•/C. - )
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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Applicant's signature
/
CAM
icialXstgnatu're
Issuing
date
Expiration dafe
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