General Permits (5297)

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CERTIFICATION OF EXEMPTION
Y- 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 pursuant to tICAC-Snbckrapte"r-7-K-:0'203.
Applicant Name Phone Number,_ j ;S
Address
City __ State Zip Gt�
Project Location (County, State Road, Water Body, etc.), 'Si g C,, cac; `--AA k 1iuu
i„r �. G.. Y ti^.y, r•. i'Y"C:l. � ',1�..,.��`Lyy�. .-.rt \. - Wit-,:\
Type and Dimensions of Project u �. '-i X, w t
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15• NCAC 7K 0203. 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 90: zs from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE:
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s
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t
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w_ ..L... ..A, dfh utithni it the rnn- i C
sent of a CAMA official unar'the mistakeri assumption that the
development is exempted, �i)l'be,in violation of the CAMA if there
is a subsequent determina ibq that a permit was required for the
development. Eli,
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The applicant certifies by Sett tjeft�t= ap-
plicant has read and will a �3�T1��11tt���++ emp-
tion, and {2) a written state er3�LribbtdlfTC�d1i'T"dupcent
landowners certifying that they have no objections to the
proposed work.
` Applicant's signature
CAMA Official's signature
U, i.�i\kcw kc1cl:j
Issuing date
Expiration date
Attachment; 15 North Carolina AdministrativeCode7K _0203