General Permits (5837)

CERTIFICATION OF EXEMPT!
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, Y {�
Department of Environment, Health, and Natural Resources and the Coastal Rest riAAA
in an area of environmental concern pursuant to 15-NCAC Subchapter 7K.0203.
Applicant Name ' "sic-.- `2� -Nc,, 0 Phone Number
Address
City State tiJt... zip '1,Y hck
Project Location (County, State Road, Water Body, etc.) fit-_ �i..�•`; ` tt �,'��,� "" `,v . , �r
Type and Dimensions of Project X (a )s ,Its
0.
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°-NGAC=7K-w: 203. 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.
I SKETCH (SCALE: I I 1 11 ) I
L , 1,�','141 '1. r- 'V A .ra
1 1
Any person who proceeds with a development without the con-�--
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for thee, development. CAMA CAMA Official's signature
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.
Issuing date
`,1 ,. ` C,
t�. \. a
Expiration date
AtfA'cfiment: 15 North Carolina Administrative, Code 7K .0203