General Permits (5236)

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CERTIF- ATION-:_QF EXEMPTION
9
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 pumuant-to-4-5-NGA� Subehapter 7K-(a03.
Applicant Name
Address /vU Firmer: -k.
City :,-ti
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Pro
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant,to-45-140A-C 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number P&/- 88S -_1 " 3"
State 12 -i Zip 61849
C� • � / % Jr
This c(�irf-fication 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.
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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)_aw.ritten.statementhas.k�ee�obtainedf.romad)acent
landowners certifying -that they--have--no-ot5j-60ti6ns-'to the
proposed work
Applicant's signature
�1
CAMA Official's signatu e
Issuing date
-3/-S7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203