General Permits (5665)

—Y
CERTIFICATION 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 pursuant to-1-5--N AC Subchapter7-K :0203.
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Applicant Name LJ . u�\� . `'��� ��G- e,' Phone Number cM0k•`)%a
Address � .) ,
City "; l State Nc- Zip -o t 4
Project Location (County, State Road, Water Body, etc.) o SRI 004 0, ,\'�A: �c
! i] 3
Tyne and Dimensions of Project S 1�„- �- G r�`L - r-\G c a ,-� X
%�: C - • - 1
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to "151VGAC 71<1 —203-.-This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
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.
This certification of exemption from requiring a CAMA permit is
valid for90-day-s from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE:
,—Applicant's signature
CAMA Official's signature
ALA N P M �_ 1Cilc\
Issuing date
Expiration date
Attachment:Ii s t4brth-CarotinaAzfministrative-Code 7K .0203