General Permits (5679)

CERTIFICATION OF EXEMP OTLJrA%
-� FROM REQUIRING A CAMA PERMIT PR 28 1997
as authorized by the State of North Carolina,L' --'
Department of Environment, Health, and Natural Resources and the Coastal Resoul mission-"""'
in an area of environmental concern pursuantp`15 NCAC Subchapter 7K .0203.
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Applicant Name t `r -=c I iv'S /' Phone Numbet'1
Address +, —' ki P
City ' _p State
Project Location (County, Mate F oad, Water Body etc.) A
1
Type and Dimensions of Project -r 1
(" ci I �J ci.
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 .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip '?�C
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.
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SKETCH (SCALE: ! )
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n1 iy rclavii rivvvv..., .. .... ....... ..r....... .. ..... ...... .. ... .._..
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.
Applicant's signature r
CAMA Official's signat
9
Issuing datg
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203