General Permits (5671)

O
CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, %-
Department of Environment, Health, and Natural Resources and the Coastal R irLJ'Y- Y
in an area of environmental concern pursuant to `t•5---NCAC Subchapter 71 131111111180Nlose a666686MM00
Applicant Name L,'J'N Phone Number's VN -
Address ' 't✓ �ti
City A, State zip-���'�
Project Location (County, State Road, Water Body, etc.) N, t4-,
� 4
Type and Dimensions of Project ��or Uti1•:,.,h ,;,' : ,.._ "ii,' aJ�;`:. �, i.�t.i:
L Ir, _, . .
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.!NCAG 7K :0203: This exemption to
LAMA 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.
I SKETCH (SCALE: (Vut,, , _ ) I
`lc \r1N -b I...
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. 6r
0J
Applicant's signature
CAMA Official's signature L
7). `�J��L \
Issuing date
Expiration date
Attachment: 15-North Carolina Admin1ttrative Cod*7K .0203