General Permits (5314)

CERTIFICATION OF EXEMPTI ` `
_Y FROM REQUIRING A CAMA PERMIT J U N 1 9 1997
as authorized by the State of North Carolina,L1?
Department of Environment, Health, and Natural Resources and the Coastal Resauxass_GDatissiDn _____,.,,
in an area of environmental concern pursuant to 1'S:NCA .Subcliapf,64�7k_02-03.
Applicant Name �01�� �� �' �- Phone Number 9)` - �000
Addressl\
City N_ Stat t,, . Zips ?3`cS`t
Py, roject Location.(CountState Road, Water Body, etc.) �, ; �, � . 1 A�1Lo
_
Type and Dimensions of Project �(r. _ c�Ja sY w.�_ - - �lr cA pX..r-16oCN, I�' x 'Q; u o`s —V,0.
/.' . 1 , , . � . - A . . Rv .+
C. -)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1'&WCAG 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 90Aays 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: .` )
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.
_AZplicant's sigrfatuw
CAMA Official's signature
Issuing date
Expiration date
Attgoh- it 15 NoTtli-IGarolina-Administrativa- cde-7K .0203