General Permits (5068)

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CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT JUN 1 9 1997 6�
as authorized by the State of North Carolina, l '
Department of Environment, Health, and Natural Resources and the Coastal lsources Commission
in an area of environmental concern pursuant -to TS NCAC•Subdhapter7K :0203. -2)A
Applicant Name . Phone Number fyt,,
Address -s e
City ^ : r,. 1 ° State _e r Zip
Pro ect L cation (County, State.Roa , Water Bod , etc. a�vE; Yes f (go ��.*hp� n /� �� 'TA19. 1
KN
Type and Dimensions of Project /.OLA "4 77&tilwee q, tiv Lr .o /,-(x T
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to- 1.5-INGAG-7-K•-:0203:"fhis 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 for90-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: • )
+ �Ve , ' fu .
_+x', E .. : ia•
n ...... ............h.... --Aa 46 o r4ovcl^nmont without tho rnn-
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.
,41c' 1
Applicant's signature
CAMA Official's signature
r
Issuing date /
Expiration date
Attachment: 15 North'Carolina Administrative•�Code -tF :0203