General Permits (5100)

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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 15 NCAC Subchapter 7K .0203.
Applicant Name 6V
Address
City A -pe v -7State
Project Loc dofer",
C9unty, State Road, Water Body, etc.) e �P
Ruf )h h--3eV_-1 db. , ,.Z Ir r
Type ark Dimensions of Project
Phone Number % /2 - 7,2j4'? /
A
Zip !
,IV r.
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to are; arWation of the project and project site maybe necessary
4 ,;
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH 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.
A t si ature -
CAMA Official's signature
Iµ21. 1I
Issuing date
', 7
Expiration date `
Attachment: 15 North Carolina Administrative Code 7K .0203
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State of North Carolina
Department of Environment,
Health and Natural Resources • A
Division of Coastal Management
FA
James B. Hunt, Governor
Jonathan B. Howes, Secretary F C F1
Roger N. Schecter, Director
DATE: 9- q , 1996
a14S R..a0 R.
Dear rt.,p_ \It),,%
Attached is a Certificate of Exemption From Requiring a CAMA Permit. In order to
validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy and
the attached regulation (7K .0203) for your files and return the blue and green signed copies to
us in the enclosed, self-addressed envelope.
Your early attention to this matter would be appreciated.
Sincerely,
Field RepreUtative
/dh
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #1 1-12-09
Teiephone 919-726-7021 FAX [phone]
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