General Permits (5461)

CERTIFICATION OF EXEMPTION --
FROM REQUIRING A CAMA PERMIT ; DEC
as authorized by the State of North Carolina,.r ..:�
Department of Environment, Health, and Natural Resources and the Coastal c rces Go#x ",
in an area of environmental concern pursuantto 15 NCAC SubeiTapter
Applicant Name 'L/ V.,o,Z Phone Number r�%f%J
Address e cr r'
City State zip ,r
Project Location (County, State Road, Water Body, etc.) :'� ��!�� nr> r. r'''r�. ,-�t r- s,r' f ;�<%� ✓��t
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to- 15-NCAC 7tf-.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 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.
112r�' ---A. F C-W,
I SKETCH (SCALE: ) I
rat �
Any person who proceeds with a development without the con- �k
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.
I
/
-7R.A. 2
Applicant's signature
ClAIVI&O ioial's signature 1
Issuing date
Expiration date
Attach ment'-15 N&ffh--EaToRW--ldmfnistrattve Code-7"203