General Permits (5691)

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-� 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-l"eABSubchapter_� 42_93_
Applicant Name � ^ c r � r H Phone Number �'%;' ct
Address. P. y_ 3yY' /3
City i-Ft t 2_xlijP- -J State r! c Zip 5 A1.3
Project Location (County, State Road, Water Body, etc.) �? �A fJ ,_CTC T <- v
21".—il 1� r. =�( i1 ��h) ��M, 1 ��� (<'V�c� r4� •�� rz r ti
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Type and Dimensions of Project IZ_1t= ao: r} ,�.a r_ z — I � Fr. cfx, r ,c 4�„
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursaam=k;-�GA-G'7K .GZ 3. 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�f-d_ysfrom the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH
(SCALE:
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.
Applicant's signature
CAMA Gtticiars signature
Issuing date
Expiration date
Attach ment'15-North Carolina -Administrative -Code 7K .0203