General Permits (5597)

CE.RTITFA - 4ON 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 puns ;taa15.'NeAC;�SffpCer-7K-�iG2Ga.
Applicant Name v e / /r n
Address /Z 14ZA--
City
Project Location Couu�'j/,j��ty, State Road, Water Body, etc.
Type and Dimensions of Project a%
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuants4o-4,6wNGA{'r-?'K--0203-This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number 919, _39-?- r y0a
Zip
/ Eke- o
This certification of exemption from requiring a CAMA permit is
valid for-9OWays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
.. k
SKETCH (SCALE:
Ora
►C / �la�rar f�i'�'IDin� 1
26- 9r 41— /c9/
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 wr-ittenstaternent•-has-been obtained from adjacent.
,landowners -certifying that they-­have.--no-objections-to--the-
propos,sdrwork.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203