General Permits (5247)

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103 "1;: i 76/c'
• CERTIFICATION -OF EXER
-r
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and th
in an area of environmental concern -purs"nt-t&1-&-NGA0 utscha
Applicant Name
Address %;�--
City State Zip = ' J'
Project Location (County, State Road, Water Body, etc.)n�„ �- !�• , '-� 1°
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llSSEP 2 4 1�6
al.Resources Commiss'
Phone Number YS 3s-C 6d
Iype anti Dimensions of project -A
^ ( r
The proposed projectto be located and constructed asdescribed This c6nifieataon•of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90-days from the date of issuance. Following expiration,
quirement pursuant -to 15 NOAC-7.K­.0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
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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) a written statement has been obtained from adjacent
landowners certifying that they -have no objections to the
proposed work.
Applicant's signature
CAMA Official's signature
9- /�
Issuing date
I
a
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

State of North Carolina
Department of Environment,
Health and Natural Resources 4
Division of Coastal Management
James B. Hunt, Jr„ Governor
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
DATE: 1996
�ss� yg6oeo /f1 C 2ssiS
Dear
Attached is a Certificate of Exemption From Requiring a CAMA Permit. In order to
validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy for
your files and return the blue and green signed copies to us in the enclosed, self-addressed
envelope.
Your early attention to this matter would be appreciated.
Sincerely,
Field Representative
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Enclosures
P.O. Box 769, 3441 Arendell St., Morehead City, North Carolina 28557 Courier #11-12-09
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