General Permits (5050)

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f 10ERTIFICAT[ON QF
=,. r ::z t �:. EXEMPTION 4
«r FROM REQUIRING ,.:: - .x..: ;. ,,, -
-A_C_ AMA -PER_ Ml_T ' .
'•� as authorized b the State of Noit Y .. h�Cajolina,
' ti Dep3itment of Environriierit, Health; snd Natural Resources and the Coastal Resources Commission
I m an area of environmental concern pursuant to 15 NCAC Subchapter 7K 0203
( ApplicantrName -r ��•!LY Jk.� - —
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ress'r d one Number
I City. :State
i Proje t toca, ion (Co' .ty, State Road afar Body ) Zt ".d
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The proposed prolectto be located and constructed asdescribed -This certiftcatlon of exam ion from re uinn to LAMA p 9 p• ' �'_ above is hereby cert,fied as exempt from the CAMA permit re- valid for 90 days from thedate•of issuance Following expiration;`-``, `
c�uirement pursuant to i5 NCAC 7K .0203. This exemption to a re-examination of the protect and project site may be necessary
` CAMA pet m!t requirements does riot a[Ieviate'the necessity of :._ #o continue this certification _
your obtaining'`any other State; Federal, or Loca( authorization. "
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' Any person. who_ proceeds i+ ith a development without the con A
-'sent of a CAMA official under the mistaken assum tion that the
p iJApplicant's siofia ure IV
j _ development is exempted, will be in violation of the CAMA H 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.
Ux 0 h
CAMA Official's signature
Issuing date
Expiration date
Anachment: 15 (forth Ca.-clina Administrative Ccde 7K.0203