General Permits (5147)

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C-ERTIFICATION -OF EXEMPTION 9
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 pu ant4e 1'5�WCAC SUbCtiapter 7K .0203.
LOu ASCA-)
Applicant Name /- " dA t j
Address :`/ Z Zr-;
City
City 'r`
Project Location'(County, State Road, Water Body, etc.)
Type and Dimensions of Project F
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- NOAC-7W0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
ISKETCH
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.
Phone Number i �_ C
State Zip
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.
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OCT 0 19%
Applicant's signature
CAMA Official's signature
Issuing date
7 - _iJ
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203
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OCT 0 4 19-6 I

State of North Carolina
- ` Department of Environment, N19;Tj
Health and Natural Resources A4 • a
Division of Coastal Management
James B. Hunt, Jr., Governor Ll
Jonathan B, Howes, Secretory IC
Roger N. Schecter, Director
DATE: ,�P�l. Z 3 1996
��ti1a✓ AIC 2,.ri,6
Dean. L4^n_rv_41�
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 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,
.41. � %~ a �/
Field Representative
/dh
Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #11-12-09
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Y EXEMPTION f .
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 3.
Applicant Namer
Address_
City �,,, � State
Project Location ounty, State Road, Water Body, etc.)
Phone Number 72Y llii o
Lip ;_/Y5 /E
Pw
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement . This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This &zj��ara�}dn from requiring a CAMA permit is
valid for_
� 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-
3 (SCALE-3C 2ui17- aiu
�S
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) arit�a��
�'* r`o rt�f�hPy have no Oblp^tinnc to }ho
pry -we rk.
Applicant's signature
leH/ %r,
CAMA Official's sigKature
1/-23-iG
Issuing date
S-31)-i_7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203