General Permits (4607)

CERTIFICATION OF EXEMPTION. 0,VA/
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, NOV 2 4 19H
Department of Environment, Health, and Natural Resources and jthe Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subcftapter'71<.0203. -/�'`n T
Applicant Name 4t i'= 1' t ' e �' , wC a ?,F 'ri eg. Phone Number
Address v `a 1 r
City i I ,= r- State C zip 4- h VO
Project Location (County, State Road, Water Body, etc.) szt�-
Type and Dimensions of Project P4' PA R () �:'_
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.
,v%A zv T<
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: 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 to the
proposed work.
Applicant's' signature
CAMA Official's signature
(-) 9 �r
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203