General Permits (5344)

CERTIFICATION OF EXEMPTI FEB o 7
FROM REQUIRING A CAMA PERMIT
2
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resi��114�i���
in an area of environmental concern pursuant to 1,501G 5rafachapter"Qa.
Applicant Name \NPhone Number `�i1�• �1rN{ • �i�55
Address \10 (o a, .VS N
City r State Nc- Zip a
Project Location (County, State Road, Water Body, etc.) Pee rCX"
Type and Dimensions of Project `W X "- W w 1\ a ra x aU
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1-5±1CAG-42D& 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 96;dags.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: WtV%�_ )
Any person who proceeas wan a aeveiopmeni witnout ine wn-
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.
lica nt'ss sign ture
CAMA Official's signature
Issuing date
a
Expiration date
Attach­m—dnT"1'S� o