General Permits (5171)

CERTIFICATION OF EXEMPTION
_Y 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 pursuant to 1' AC S-ubcharptea•_-7+<--.�- ©3_..
Applicant Name I,c,. \_c," Phone Number 15 bg
Address
City State N Zip i 7i 10
Project Location (County, State Road, Water Body etc.) ®% S \4t4
Type and Dimensions of Project - Aa
C,1_�ir.Yl — V- 0\\ is tI,, L A�. DA',r O G. ,' -Aa "
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1-5 AC__7X_ Q2TJ-This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This c(-rtification of exemption from requiring a CAMA permit is
valid for ftrb= from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH
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Any person who proceeds with a development without the con-
sent of a CAMA official under t p mistaken assumption that thip
development is exempted, willJ�hf!at�asreguiredfof.the
�iblatidn of the CAMA if there
is a subsequent determination mn
development.�1 1997 `; {
The applicant certifies by signij
plicant has read and will abid
tion, and (2) a written statement has been obtaine t
landowners certifying that they have no objections to the
proposed work.
Applicant's si nature
CA Official's signature a
Issuing date
.�>\ \ AK)
Expiration date
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