General Permits (4194)

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Applicant Name
AddressA_� ca
City
Project Location
A/c/ k s, i'e_eA n e� Be - IA'1. / �­ "; / 9171<
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 pursuant tor1.5-UCA"ubchapter.74<-:0203.
ounty, State Road, Water Body, etc.)
Q "V / C W in P A A Ad it
State
Phone Numbers
Zip
Type and Di mensionsofProject P4 0e' P_ a_ sy A,,,'o le 05.PJ- Irvf vl. /_9 4
a -e i. J'9 IPr i.J a Ad P r1 fi '0&' e'/,( 70 ,. %., .. , . U i• . r� �, r r v n. e r
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-'NCAC"71<'-G2Ol. T-hia-exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid 1cT 90 dayT"from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH 11(SCALE: /'✓'Orr ) I
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I J _ i i !___ _ _ _J
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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Attach meat, -15-North-Caro}inaa ministrative Code 7K.020