General Permits (5173)

Applicant Name
Address _1�?
City ', \ �..
Project Location
CERTIFICATION OF EXEMPTIO1
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resou
in an area of environmental concern pursuant to 15-4 4C-Sutmbapter 7K--.eL03.
Phone Number '�A\q • 716i SM
Type and Dimensions of Project S�� 't►,t`c,c,.e_ c+p x,� ' ow, a Y:CVn'r)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 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 9&d4s 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: 'NQ .3e_ ) I
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.
i
_ 9 C-71 O
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is fgignature
l%
s signature
Issuing date
_ ll
Expiration date
AffachrrrontsaraAortWGaro4na%dminisfrative`ode 7K .020