General Permits (5375)

-Y
CERTIFICATIO-N OF EXEMPTION
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-15- NCAC'Subchapter•71K ,0203. . 76
Applicant Name .i?r�^i <<;;{,�r;t, it� �v �.,s,,.,> Phone Number
Address f 0
City F ''" r State AJC Zip 'VC
Project Location (County, State Road, Water Body, etc.)
>!•«a < t r:' i,.�: ✓ Grt: � f ' :.•=•y,, �l:y if ..
Type and Dimensions of Project 34., ! f ��{` ��°: �f 7, ,/"'t' .
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuantto 15 NCAG-7K`:0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
ISKETCH
This certification -of•-exemption from requiring a CAMA permit is
valid for 90-.days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE: )
s
e.
i�,fj�.9._f!(�Din%'�. ia,?-�' '�"�,�+r^r�f!^G�Y�F� (r/C;,li.t•d.
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.
xv
Applicant's signature
CAMA Official's signature
Issuing date
;f
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203