General Permits (5026)

OF EXEMPTI`�
CERTIFICATION
FROM REQUIRING A CAMA PERMIT r_S'R g� 1gg7
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Re+i�w�.���liiNssiylr
in an area of environmental concern pursuant to lS5:NCAe�S-ubchapter7K-.0203.
Phone Number t�
Applicant Name } �c_ c, �� �, S h
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Address � Lit � �•- yi r; `s lZ c,&"
City c : State 0Lt Zip
Project Location (County, State Road, Water Body, etc.)�,J-,Sts� s
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Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1S-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 tb .__.._ , (SCALE:
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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.
GCG.a.SS �—
Applicant's signature
CAMA Official's signature
_s �1 � DIAL ! aCV1
Issuing date
Expiration date
Attachttff6nt: 1S-NorTh-rArolina Adminfsrrra�"e ode 7K:0203