General Permits (5912)

C.ER.TI.FI A-TI-ON OF EXEMPTION rd
FROM REQUIRING A CAMA PERMIT
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 ot4 suant U;= UCAC 4uhchaptez.7J6-0203-
Applicant Name
Address 4-2.3
City .:
Project Loc ion} (Cou
Type and Dimensions of Project
Road, Water Body, etc.)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuarat .to-•16-NCA0%7K :02G3. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
/ State
1GY1 ✓i PC
RJAL.�,('
;?r e;r
Phone Number 7
Zip
This cficationo e iexemption from requiring a CAMA permit is
valid forays 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: �,t,,rjL,, ) I
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L /
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eY /X,
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•obtainedirom a` =eai.,
landowners:::=certifying -that -they. haver -no- objeetiens-.tQ-tLeie
proPQsed-roerk:
{ / �� ' ' r >�t/ A A�� �; t �/ �u/• ,,ski, -%`l. � .
ap icaht's signature
CAMA Official's signat. e
Iss ng date
�J- Si-c"7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203