General Permits (4411)

CERTIFI-CATION-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 15 NCAC Subchapter 7K .0203.
Applicant Name &tour•/ �r'�<r�',4,e7rl
Address 4wo R'yc,.
City W s X0,"
Project Location (County, State Road, Water Body, etc.
I ype and Dimensions of Hroiect
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement purseaat: to- 1•5v->NOAG 7K .02.03, This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number 12-10 6 Af
State A) _ _ Zip 11-/
This ccrtificatqd9_f exemption from requiring a CAMA permit is
valid for-904ays-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:+�� )
all, e fir. G,`SOr 10-4./ 3 �' .ZG � /'Ci L c/wf � • �--�.P1C,S
).
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 beenobtained from adjacent
landowners certifying that they have -no objections to the -
proposed work:
Applicant's signature_
CAMA Official's signature
,. - /9- q e,
Issuing date
9 -3.,- 17
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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