General Permits (4311)

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ApplicantName i�can L�\E,c,c tom..
Address 6-1 �.:. ,�-. • �, � t.?� j •
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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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 to ?5-NCAC-Svbchapter 7K :02t13.
Phone Number - (,,U_)_)
State- Zip
a. ,. L�x_
This certification of exemption from requiring a CAMA permit is
valid for 90.,.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::`
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Any person who proceeds with a development without the con-
sent of a CAMA official under t iyt st mPlipn that thb,
development is exempted, will b i ibtiro t�e�6PAA if therei
is a subsequent determination t permit was required for the i
development. 0[ MAR 2 1 1997 �
The applicant certifies signing 1I
plicant has read and willll abide �yi� t
tion, and (2) a written statement IRisbt�rnvbte�n�d4roradjee�eAF
landowners certifying that they have no objections to the
proposed work.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachrn64 :1.5.North-Carolina Administrative-eo�7K .0203