General Permits (4613)

12-1
EXEMPTION
OF EXEM
-Y _
FROM REQUIRING A CAMA PERMIT IV\ '�= i'•L i��1
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commis dN 2 9 1999
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K-:02:03.
Applicant Name `� 1 \ ; ,'� 1,�; ���r ,'1V Phone Number Z`; Z '
Address ��� '�. �•m�.l�-L
1 ti�
City `, ; State Zip
Project Location (County, State Road, Water Body, etc.) 1 wA_ 1 .-1A �,;
Vlk
I ype and uimensions of vroject
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.
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: )
k,..�,� � � to r...._.._......_.._..
� 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
Issuing date
Expiration date