General Permits (5720)

CERTIFICATION OF EXEMPT PN
_Y FROM REQUIRING A CAMA PERMIT J U N 1 9 1997
as authorized by the State of North Carolina,
.,.-C".. .. -
Department of Environment, Health, and Natural Resources and the Coastal
in an area of environmental concern pursuant to15-NOAC�Subehap-_______�_.....,.-,.
Applicant Name
Address r '
City
Project Locatior
Type and Dimensions of
a Je, `Y r,S rr u
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement parsu'a ft-f'o"i5,1V-CAC`M-.-0203. 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 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.
SKETCH (SCALE;,'�D.
'Tu Pa,a.,l�cp iP�i ey �b
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63 ,
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 Official's signature
Issuing date
Expiration date"
Attachment: -15 North-Earolina-Administrative"CodE 7K .02d3