General Permits (5835)

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CERTIFICATION OF EXEMPTION���
o ;.,
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources �fflflf'mstima.Va
in an area of environmental concern pursuant-ta l6-t4GAG Stfbehapter-7lK.,Q203__
Applicant Name Phone Number
/ ,ice,
Address ��� ��, r; lv�;�.` ,fir
City '�� '� State iii �' Zip
Project Location (County, State Road, Water Body, etc.) /,� c�� a�,, I1,lr _fir_ /1w 5/ .41;z;
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Type and Dimensions of Project '� �:�rc�� ' S'"/ �, r` /u ' N ./ n-
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant-t4 -1'5-NeAC. TK--X203. 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: )
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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
CAMA ial's g turer-
Issuing date
Expiration date'
AttachEra'eiii -15 North -Carolina Administrative. Cade-7i- -.0203