General Permits (5925)

C.,ERTIEr'C N EXEMPTION
FROM REQUIRING A CAMA PERMIT { p
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 Pursua tto-lsNt AC¢SulichaTpter M• 0203-,
1_
Applicant Name / - .' "` // :
Address J, 4 % Z Ao 4, , 0
City 6a; . tz1G..o
Project Location (County, State Road, Water Body, etc.) _
Type and Dimensions of Project
�,Er.ra
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement_pu,rsuant-te—t-5 NOA6-'7K-"0203: This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
State
Phone Number . " _= Fi 7 ac
Zip SS /
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.
(SCALE: 4,., )
_CL
1
i
P7..
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 Official's sigrfature
�J-96
Issuing date
l ' '> r
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203