General Permits (4540)

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CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal'
i in an area of environmental concern pr�rsuarrt�•to'•1.5 �1C-ACSubchapter 7K-•0x
J U N 1 9 1997 E'
-------------- -----*.,
11/_ Applicant Name ?Z,?-1?V/1/-•" % pp r�lv r � �- Phone Number
Address u f Pv a d
City State dl e_. p
Project Location (Co
u
nty, Sta a Road, Water Body, etc.) ��f v .
�tC.C�� Q3� Tlt4. �AYn'f<=fi j�i✓�t- /
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant--to-+5,"NC`A"C77f :'0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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.
I SKETCH (SCALE: IDOL e) I
W Yig� rt� Cj • �. � '��'�
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.
cwti
P't V e }
I
7
Applicant' signat e � v
AMA cial's signature
Issuing date
r
Expiration date
Attachment: 15-North-Garo4n&-Adminia"tive-.odeq- :0203-