General Permits (5190)

O
Applicant Name
Address_
City 66112
Project Location
CER_ TMCk- [QN. Of E X E M PTION
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 purseantttoz15.NCAQSubch"r_7K-@2-93
Ile
r
nty, State Road, Water Body, etc.)
State
Phone Number 2 Vy oG 3.r
Zip �I XP7
Type and Dimensions of Project r :
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant toA6PNQA0 -7K—&20S_—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•9Qdays 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: _4/Gb,., ) I
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fw-o�v J
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
CAMA Officials sig ature
2• d,�1G
Issuing date
2- v - 9
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203