General Permits (5524)

,-CNN
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 15•N'CAC Subchapter 7W;0203.
Applicant Name t► \r.,c G "J►w�~^ 5 lac �Fw�• ~f;c-w Phone Number �.
Address a<,� . ' .; t ,ix, a%-' ?
City 'l- \: ;:_ ; - State i�4Q_ Zip
Project Location (County,- State Road, Water Body, etc.) t',-u�z Ca . �` `� �� ► l t <1 0��.
"�\:-..,]`� �C'ifi�- \c� 't�\T-.c`<_(..: il.\`we.f" l^�•:.4,- •',^_i.�fl'v?._'O�.
Type and Dimensions of Project \ �� < c.ti; ,�:, ,Grl0 -k
c_ V_ ti.. i
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 .7K. 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.
SKETCH (SCALE: )
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Any person who proceeds with a_development without the con-
sent of a CAMA official under th mistaken assumption that the
development is exempted, will be vjo "on of the CAMA if there
is a subsequent determination th permit was required for the
development. MAR 2 11997 '
The applicant certifies by signing t '
plicant has read and will abide b o -
tion, and (2) a written statement hasFeen o"6faine�'f'rS'm a8j�a��i"'
landowners certifying that they have no objections to the
proposed work.
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Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 1'S Nofth'-Caro' rina Administrative -Code 7K .0203