General Permits (5091)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT �p
as authorized by the State of North Carolina, C
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0&4f :
Applicant Name ��J�r .. Itr101.; " o t, Phone Number g� e4 7 2 9
Address �3,qi nun.. I) If 114
City "C7 r! %--0 , State 41 C' Zip 3lr
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project 0 ' hey ! f4+ ,I ?` , lY h 11+0' ..> 5 I .�l
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 ,, .20% 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.
I SKETCH : ::, I S (SCALE: ) I
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.
CAMA Official's signature l,/
- � / . ,,
Issuing date
;rs`'
Expiration date, o,'�
Attachment: 15 North Carolina Administrative Code 7K .0203