General Permits (4920)

CERTIFICATION OF EXEMPTIF.,U L 0 6 1992
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, L.�jd [FLL:!..�
Department of Environment, Health, and Natural Resources and the Coastal Ruuissiraa�..�.�...:�
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Ft� P F_ 5 7 l_ . ca & e—;r-
Address I ryC /-,, i )� DA
City
Project Location (County, State Road, Water Body, etc.)
KILL- DF—yrt
`.- c t
Type and Dimensions of Project' G,• 57`K=��
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.
Phone Number &C 4 - «b E - 36—tD
State VA Zip 3170
E �iCJVYT S%. 31,44 P_ t4 yr b"q/t:e
71v Y A u.+CC a,4 V o FF A L 4FM Am c r=
NF_ A
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 F C, -_ �5 5 P T11V (SCALE: / = 30 )
Ex
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.
'tom/
Applicant's signature
CAMA Official's signature
2_
Issuing date
/? .r 192
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203