General Permits (5334)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
70 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 p 23
Applicant Name 17� t k_�_ M 04 C,A,J Phone Number (a f �
Address 3 Z t Z
City wti State rJ� Zip Z-7 97
Project Location (County, State Road, Water Body, etc.) 'i�i t; i-,� v %::�p,2 F _zrp_ 5 ,z t 4
rAYU+�t� 0>y T�l,►.tLic t'�yC_-,Z ti�
Type and Dimensions of Project It z x f " 7 " ,4
The proposed project to be located and constructed as described This c—tification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 9II-=ys from the date of issuance. Following expiration,
quirement I I I R P I 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.
-A
SKETCH
(SCALE: l Q &j 15 )
N Gk
1 1
f
Mi `0 Cv
I
`ice
I
Any person who proceeds
with3=Ra t��vetchle'ftt`wFSput'f pn_
sent of a LAMA official under
develcpment is exempted, will
is a subsequent determination
development.
.is�akeh a�sgrA�UoM iha
vloration of the CAMA if t
a pQrtp{t weslelrtir V fo
The applicant certifies by signi �' a 1'1'T4-;jP
plicant has read and will abide
tcn, 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 Qfficial'ssignature ✓
Issuing date
Expiration date
Atiachmcjni:-1sAlartix�aratuz�r.Ar�ia ,,., tr 03