General Permits (5156)

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CERTIFICATION OF EXEMPTION`"L :_ .�.:.
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L 8 1997 � 4
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, -10 U L:- IJ
Department of Environment, Health, and Natural Resources and the Coastal Resources -----------
in any area of environmental concern pursuant to 15,t4OAC Subchapter 7K 0203.
Applicant Name Phone Number '1 - '?5 J,r I
Address , J Pwx
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City - State zip:
Project Location (County, State Road, Water Body, etc.) ca#
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 pursuant to 15 'NGAC 7K4.020a.,T-hris-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 (SCALE: ) I
a
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L&Sv.t.r_ ev
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.
1l
1
plicant's sii nature
Official's signature
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Issuing date
Expiration date
-Attach' -L6d-_1:5 N6WCar61inaAdministrative-C6de-7K.0203