General Permits (4261)

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-� GERTIFIGATION'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-pe*saafitio-15•-NOAC-SubehapWr�7K .0203.
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Applicant Name Phone Number 4 Ss AM
Address
City State R.G _ zip r..`> 62
Project Location (County, State Road, Water Body, etc.)E���ati
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Type and Dimensions of Pi
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-NGAC:7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
This certification of exemption from requiring a CAMA permit is
valid for-Ra-days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE: )
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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) a writtemstatement has been obtained from- -adjacent
landowners-certifying..tbat,-they have no., objections- to -the-
proposed work.
Applicant's signature
CAMA Official's signature ?�
Issuing date T Z 4
Expiration date .
Attachment: 15 North Carolina Administrative Code 7K .0203