General Permits (5655)

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CERTIFICATION OF EXEMPTION rof
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 NCAG Subchapter 7K .0203.
Applicant Name S14%/1
Address
City
Project Location (County, State Road, Water Body, etc.)
State
c., C
• utr
Phone Number 97.1-6760
Type and Dimensions of Project�Y�
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-.-:o203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip ,7 7Y /?
This certification of exemption from requiring a CAMA permit is
valid for9D 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: ) I
i
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c/ter fe i70 /PC .1�'%
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) awritten statement has been obtained from adjacent -
landowners certifying that they have no objections to the'
proposed work.
tA>k(E r)
a J?AP
Alicant's signature
CAMA Official's sicJnature
` ,« i-7
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203