General Permits (5526)

O
CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT
FEB 2 0g97
as authorized by the State of North Carolina, �aarw4��/e�n���esenawe//►//►ep
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15-NCAG Subchapter 7K 0203..
Applicant Namey�r .�> `'a�U Ctir�. Phone Number 'plc► - `:S" )!, 4) 4''j
Address
City State Nam. Zip :X'' "Q
Project Location (County, State Road, Water Body, etc.) i3s r, vim: -"°, v�.0
Type and Dimensions of Project ; t"u4 C_ tea.'.,.
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15NGAC°71K::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 9 -6ays 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
L
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.
Applicant's signatur
CAIMA Official's sianature
Issuing date
Expiration date
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