General Permits (5415)

CERTIFICATION 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 1". .CAC Sttbehapt;er3*w*2W.
Applicant Name
Address k3"1
City
Project Location (County, State Road,
, etc.)
State
At- '1-5 %0 - 4t %% I #,Yq
Phone Number ONck • ` V • 6sks i\1+)
Type and Dimensions of Project ' r 4,S4 = 14 1 "
r
AU i
MJ0P
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to fiz:.t Ot2k .:`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 RELdo from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: ) I
Y
I 1 �
Any person who proceeds with a development without the con-
sent of a CAMA official under the ssumptibn th2t the
development is exempted, wilt be i Wit Vtoe'e
is a subsequent determination tha ermit was required for th}
development. n MAA 2 1 107 i
The applicant certifies by signing t
plicant has read and will abide byft r . i
tion, and (2) a written! UITNI'i't-2!'f�
landowners certifying that they have no objections to the
proposed work.
CAVA Official's signature.
Issuing date
IA ^ice.`\ 15C-1
Expiration date
Attachmerlf 15 Nortli-Carofirra-Administrative Code 7K :0203-