General Permits (5578)

CERTIFICATION Or EXEMPTION 9p
FROM REQUIRING A CAMA PERMIT
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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�NGAGSubchapter 7K :0203.
Applicant Name 4.1, A, Phone Number
Address
City State A _ G:: Zip
Project Location (County, State Road, Water Body, etc.) ' ;'' /2
Type and Dimensions of Project T. IL.!,
f All
The proposed project to be located and constructed as described This ceitifieatian.-of--exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for-90 as-ys from the date of issuance. Following expiration,
quirement pursuant to-1 &- NCAC 7K-.0203: This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE: )
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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-beenobtained from -adjacent
landowners -certifying that -they, have -no- objections -to - the_
proposed work.'
CAMA Official's signature !
Issuing date -NOV 04 19%
ill
Expiration date -+vI J .1 IJ i.—tg.,..-
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Attachment: 15 North Carolina Administrative Code 7K .0203

1k
• State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Coastal Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Roger N. Schecter, Director
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6_reto, v.'1%, S'�' 296 07
Dear L,n
4 10
CD E H N FR
DATE: Al 2// , 1996
Attached is a Certificate of Exemption From Requiring a CAMA Permit. In order to
validate this permit, please sign all three (3) copies as indicated. Retain the yellow copy for
your files and return the blue and green signed copies to us in the enclosed, self-addressed
envelope.
Your early attention to this matter would be appreciated.
Sincerely,
Field Representative
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Enclosures
AW
P.O. Box 769. 3441 Arendell St., Morehead City NC 28557 Ni 6 An Equal Opportunity / Affirmative Action Employer
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