General Permits (5122)

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 pufstiaamo-1-5 NGAG apter 7K:z8203.
Applicant Name I _� ON A� i, h . L /, r-A r_i Phone Number ( W) G- 4 'jz
Address I' u P u v 9 r-, zL4
City I� /I I S c) ti State vi c Zip . 7 E F c
Project Location (County, State Road, Water Body, etc.) T= a, /r s r 1-7 _� 0 A
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Type and Dimensions of Project Tr- ...A C:r, 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 tc 15=NGAG---7K --0�. 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 9"-ays 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: Ih I (j r )
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1-IV
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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.
kApplicaht's signature
CAMA Official's signature
Issuing date
i t !
Expiration date
AttachrnontL15 North -Carolina Administrative Code-7K-0203