General Permits (4708)

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CERTIFICATION 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 Resourr�yt��oq�rr}isIN
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .020€1. IYY�I 11 UU II
Applicant Name Jr ` A tom! �� pl L_ 11.3 1 C-
Address J �4 4
City , r � " �^
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project �C
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 .020t. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Numbe? r` Q 10 t - Zi L4 2�
State t- -! 1_, — Zip
•.: J-)f I 1
0%^
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: NJ -j' C, )
Any *son who proceeds with a development without the con-
sent -off 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.
It., L
C_ I - � A. -�_) o UJ
I- � T
Applicant's signa ure f y�
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0200