General Permits (5160)

CERTIFICATION OF EXEMPTION� l s 1997
FROM REQUIRING A CAMA PERMITb & n- Z-2 L 35 U"u
as authorized by the State of North Carolina, .,_7___r_�„ ..
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 3VurPhone Number
Address
City K.:State 1` k_ Zip
Project Location (County, State Road, Water Body, etc.) N-�c
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 NCAC" 7K -.0201 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 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.
SKETCH (SCALE: Nyvti )
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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.
Applicant's signature
CAMA Official's signature \
Issuing date
Expiration date
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Attaahmm-e� 5 North CaroTiha Administ'rafive Code 7K .0203