General Permits (5161)

O
Applicant Name
Address 1; D
City 44
Type
CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT 6ure
�'Y 1 y '�y� N''
as authorized by the State of North Carolina, ��--•,�i1�� t��j
Department of Environment, Health, and Natural Resources and the Coastal ResorrifTfT�16i't'
in an area of environmental concern pursuant -to 15-NeACSrubchapter 7l�:t
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant'10-15-NCA7"K-.'GZG3--This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number �fn
This certification J exemption from requiring a CAMA permit is
valid fer-WA'4)+S 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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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
_PAMA Off'craI's signature
ilKaZ2 7
Is ing da
Expiration date
=Attechrment: 1-5 No-rt re4na-Administrative'Code 7K-:4203---