General Permits (5054)

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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 Resources Commission
in an area of environmental concern pursuant to t}6�E S+�bel3aptQz .0203.
Applicant Name �,��,� �c�r����.p Phone Number SkQ . ':k77
Address P O
City bn�'� C` �Q �� State M:_ Zip Q-1'R I
Project Location (County, State Road, Water Body, etc.) t�P��t.�,-� Ste��p l CA
Type and Dimensions of Project P,;.,. +, / ¢ /k ��,
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant toA`LL-4 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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This certification of exemption from requiring a CAM permit is
valid for � ftom the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (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.
A_olicant's signature
CAMA'Official's signature
Issuing date
Expiration date
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Attacha;c nt -, s t`jcrth Carolina Admirfistrative erode=rrK-F 2 t3