General Permits (4322)

CERTIFICATION 0
FROM REQUIRING A CAMA F
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural
in an area of environmental concern pursuant to
Applicant Name
Address ) U L, h;n r If S
City )'r 1: "� (�f—, rr t,i
Project Location (County, State Road, Water Body, etc.)
f , ; <' j .'t>r, ci it v ✓�ci I C{C ( I ti' :ram
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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DFC �I
)urces and the Coastal 4' s urce(bmmission
State
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Phone Number (`Vl %��� jo `�' /Q 3 1
zip. f, ! (r b
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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: ;. )
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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 written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
Applicant's signature '
CAMA Pfficial's signature
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Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203