General Permits (4181)

CERTIFICATIO-N OF EXEMPTION qA
FROM REQUIRING A CAMA PERMIT (-Of
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 pu-rsuanHo-15 NeAG--Subchapter7X­.,0203.
Applicant Name Phone Number
Address
City /;,. .,.I f. /
Project Location (County, State Road, Water
Type and Dimensions of Project
etc.)/-
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant- to 1,5­NCA0 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
State 4 1
Zip
This certificdonef 'exemption from requiring a CAMA permit is
valid for 9"ays from the date of issuance. Following expiration,
a re-examination of the project and project site maybe necessary
to continue this certification.
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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)­arWrit-ten statement -has been -obtained from adjacent
landowners certifying --that they have- no --objections to the -
proposed -work.
Aoplicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K.0203

* ' State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Coastal Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
70. ao,F- scs
Dear .14. �i/aks
IDEHNR
DATE: d-�C'l ZY , 1996
T
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
P.O. Box 769, 3441 Arendell St., Morehead City NC 28557 N%4 C An Equal Opportunity / Affirmative Action Employer
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