General Permits (5197)

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 pursueatle-4&NOACE Subc+mpter 7K­m.0-2-0.
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
— ,/' ', 1 '
Type and Dimensions of Project
The proposed projecttobelocated and constructed as described
above is hereby certified asexempt from the CAMApermit re-
quirement pmnuontr-xr1eNGAG-7K-:M3. This exemption to
CAMA permit requirements does not alleviate the nacuoahy of
your obtaining any other State, Federal, orLocal authorization.
State
This exemption from requiring uCAMApermit is
valid for-9&,cbyofrom the date mfissuance. Following expiration,
are-examination ofthe project and project site may benecessary
to continue this certification.
SKETCH (SCALE:
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ai'd x:0e'.'J-t4i
C VA 41-o/6"i 7/.- rl/
Any person who proceeds with adevelopment without the con-
sent ofoCAMAofUciadundorthomiotakenoonump1ionthot!ho
development isexempted, will beinviolation ofthe CAMAit there
ieasubsequent determination that apermit was required for the
development.
The applicant certifies bysigning this exemption that (1)the ap-
plicant has read and will abide bythe conditions ofthis oxnmp-
don.and (2)awritten statement hasbennobtained-from adjacent
landowners certifying that -they have 'no otjAt�tldrno to --the
propGam&won.
signature
�(
Expiration date
Attachment: 15 North Carolina Administrative Code 7K.0203