General Permits (5189)

G ETCY�TOi 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 purswarrtio 1-5-NCAC SubchapteraK-.02W.
Applicant Name � to .s Phone Number 43�
Address- 447/ i !'l
City State /U C Zip 2
Project Location (County, State Road, Water Body, etc.) // ,/_a , //,�„ � . �1��/�/� ��j�T �� ��r�, �
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 pu.rsuant..1o,1.5- NGAC -7K .Q2&3. 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 984ays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: �(�H) 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 writfe" s nt hats -been obtained from adjacent
landowners certifying_.that-Jt_iey_ have no -objections to -the
proposed work.
61W
Applicant-s signature
(/
CAMA Official's siginature
Issuing date
%-3e-q7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203