General Permits (4384)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolinas
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to-1-5 NCAC Subehapter 7K•:0203.
Applicant Name F
Address
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.
Phone Number
State Zip
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.
c✓. AU f -
I SKETCH (SCALE: /�/fj,,,2r ) I
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 Ao .the ,
proposed work.
% (ter t /
•��'�-c. � f ,�/vim<.�
/ f
CAMA Official's signature
Issuing date
R OCT 2 2 19% 1
Expiration date
Attachment: 15 North Carolina

State of North Carolina
Department of Environment,
Health and Natural Resources 4 • •
Division of Coastal Management
James B. Hunt, Jr., Governor y V c F1
Jonathan B. Howes, Secretor
Roger N. Schecter, Director
7
AJC 28S33"Z
Dear
DATE: 4/ /6 , 1996
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 and
the attached regulation (7K .0203) 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. Pox 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier 711-12-09
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmctive Action Employer 50% recycled/ 10% post -consumer pcper