General Permits (5941)

CERTIFICATION OF EXEMPTION
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 pursuant to 1 AG-Stbehapter.7-K4 :�2-03:
Applicant Name ,(�i3Zl 5l�6i� L� Phone Number `7')
Address
City
State /%/%. Zip ,
Project Location (County, State Road, Water Body, etc.) Y zo/I/•� •'��
Type and Dimensions of Project 4o&;x 72 �
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-NGAG­7-K"­;0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
,rxr�
17gfjlJ
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:
5
C
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.
:tom Z., ,,
s signature
CAMA Official's signature,'-
6 M
Issuing date
Expiration date
Attachment 45-North Garolina-Adm?tistrative�7K-.0203