General Permits (5172)

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CERTIFICATION OF EXEMPTION
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 1-5.NCAC Subchapter 7K .0203.
Applicant Name —0 ct4, ti �`\ L C­ Phone Number
Address -C `�1( `i &N`
City . State Zip
Project Location (County, State Road, Water Body, etc.) 7{)
Type and Dimensions of Project C-c-
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 7K .0203. 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: )
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Any person who proceeds with pment without the con-
sent of a CAMA official under t s ak _assumption that the
development is exempted, will b iorrof thtCAMA ifther
is a subsequent determination t a permitwasfor
development. f idi�1R j 11 III
The applicant certifies by signi 1Wda�f
plicant has read and will abide COTU �.l��Q i
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
Applkant's signature
CAMA Official's signature Q
Issuing date
Expiration date
Attachment: t5-North.Catolina-- idmimtstFatWdCode-'7..GC--02d3`