General Permits (5651)

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Applicant Name
Address 'I
city
CERTIFICATION OF EXEMPT 4, ".%.-?-, ,t._- .�
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, JUG! 1 9 1997 I'
Department of Environment, Health, and Natural Resources and the Coastal ources Commission
in an area of environmental concern pursuant to 1-&-N AG ube F pter3 L4'.
yr Phone Num6er7
Location (County, State Road, Water Body, etc.)
State, 1.3 C-
7? K
Type and Dimensions of Project C)'0 r)
V'�" , - ,
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1'5--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: NON)E )
E_, 1 'D
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.
plicant's signature
CAMA-Off icial's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203