General Permits (5796)

Applicant Name
Address G
City
CERTIFICATION OF EXEMPTIO .� AY 161997
FROM REQUIRING A CAMA PERMIT � - T
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 15 NCAC Subchapter 7K .0203. 33 1 — / 366
or L r3 k
Fcw0 P,t
Location (County, State Road, Water Body, etc.)
(_11r; -o,e r) Bt_�? ('71 'Pd
State
t rtf A^.)S
Phone Number
G%X /Z/
Type and Dimensions of Project . t'! 4' i_V E fl /ti . f7V " t- e4 M t /Vt L Al T_
t u t (� 7 /rv6>-
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
t 3 ,S,
This c(-rtification 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: /`f r: ' )
t t v
Xu• ,7' _,y k�j (dLV f'J(-'r)D
p c K p,4u��s t
Is'llr-=� EC1C
PROPOSED
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.
signature
CAMA Official's signature
Issuing ate
Expiratioddate
Attachment: 15 North Carolina Administrative Code 7K .0203