General Permits (4429)

Applicant NameD.L•
Address S su
City oipl,f,
Project Location (Cc
GE_RTI-F1O-�T].N 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 p.ursuaat;tG1S-40AG-Subcfrapter7K :02a3.
rri" Phone Number
Road, Water Body, etc.)
V_h.
T
State ^Al c Zip c is
Type and Dimensions of Project ;„z;,. �� -,! r:.n , ' .Jfnrg,. r
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pw9u&nt4o45^N0AC rK :020&.This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
f�i- C - r,
V, 47"e
This certification of exemption from requiring a CAMA permit is
valid for gDdays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: �/�) I
i
4 .
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—#fiey have no objections 'to�-the
propos.ed•work.
Applicant's signature
CAMA Official's sign re
i 23-`6
Issuing date
--;;? P 9-7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203