General Permits (5298)

Applicant Name
Address
City
Project_ Location (C
CERTIFICATION OF EXEMPTION
/`r, 3 6 n
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 #5 P14G Se�bel�aptt�f 7tr'"6�C©3:
State Road, W> ter Body, etc.)
State
Phone Number ,%� iLzlz
Zip
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for^90days from the date of issuance. Following expiration,
quirement pursuant to45-NCft{3--M-.02U9-: 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.
I SKETCH (SCALE: /yan e,,. )
Any person who proceeds witl
sent of a CAMA official under
development is exempted, will
is a subsequent determination
development.
vpW pm n without4f}e cor
}`L v*Oonl tb tfi
violation of the CAfNA if tl r
a pM" v0slecV91 for
The applicant certifies by signing' 9"Ve1?tJiffMf"fttJ1J 1 9lp-
plicant has read and will abide tom"P
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
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Nguing date %
Expiration date '
Attach,ment:-15,N ri3�MTo—lina Administrative Code 7K .0203
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