General Permits (5721)

CERTIFICATION OF EXEMPTI ; UN 19 1997 <;
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,M_�_�.____,,..._..�ww
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15-NCAC7SuUdhApter•74<-G203:
Applicant Name K& / aS,,1
Address ' . "s
City .
Project Location ounty, State Road, Water Body,
n_ !, R I B . J
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Phone Number �•%� e�� �C"%6�
State Ar _ zip a%Sftt
Type and Dimensions of Wojett = , -/A a 4, • � ,•
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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- NEAC-7K :0203t This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
f1A1 If
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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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
Off' s g t re Ci-o-s-
Issuing date
._�y J It, 19 g ?
Expiration date
AtrAdhrWn : 15 Nort! h Carolina A~ dmir strativeZ�o e K762903-