General Permits (5253)

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CERTIFICATI-ON OF
EXEMPTION
FROM REQUIRING A CAMA PERMIT
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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 pursuant to 15 NCAC-StJbchapter 7K--:0203.
Applicant Name''
Address'�,r'
,
City
Project Location (County, State Road, Water. Body, etc.) l
Type and Dimensions of Project
State
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Phone Number6) 'S 9- !? W
Zip -VC/t..
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The proposed project to be located and constructed as described This c`ertl;frr. tioct-ef-4xemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for SG days from the date of issuance. Following expiration,
quirement pursuant to-15 -NCAG 74<-•: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'statementhas beenobtainedfrom adjacent
landowners -certifying that- -they- have -"no objections to the
proposed work.
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App1icant's signature J
CAMA Official's signature -
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Issuing date
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Expiration date
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Attachment: 15 North Carol! 'A'ifi4iirti§traTive t*o`de--M M*3

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Coastal Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
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Dear i 0I
E)EHNR
DATE: '6r 2 y , 1996
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
AW
P.O. Box 769, 3441 Arendell St., Morehead City NC 28557 N%EW
, C An Equal Opportunity / Affirmative Action Employer
Voice 919-726-7021 FAX [phone] Courier 11-12-09 50% recycled / 10% post -consumer paper