General Permits (5130)

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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 pttrsaafli-Fo-l��bchaptsr#L-ta3. /
Applicant Name _ _I ,.a Phone Number h 91 7 (_7 —,7c�%
Address t U-7
City (S tL EF�1�),Io-'g State c Zip _-Z-Z
Project Location (County, State Road, Water Body, etc.) €n, c „ . c- cr , �� r
�AC 1� .FcfS r,� 1-A,Al1Cn r),.1,=.Q
Type and Dimensions of Project _���.,, ��,, , c.r,� — R� a, oc r
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursua#-ta16��dK. 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 944ay54rom the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
—� E w Y TA
SKETCH (SCALE: t�)CY►J )
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.
1 � ,
,�cant's signature
CAYA 9ffjcial's sjgnature- 1
Issuing -date
T�(Z�/jSS-7
Expiration date
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