General Permits (5942)

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-'f5N�9,ACSebchapter,. K--02t93.
Applicant Name i �_:*dS �'r Phone Number `i\Q', - yd 530 �
Address Q✓ii V
City State Nr-- Zip u
Project Location (Coupty, Sta� Ro d, Water Blody, et 'c. \
Type and Dimensions of Project
' Pk V mi l- 4�
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to-fis NCAC=7K=:0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
01
This certification of exemption from requiring a CAMA permit is
valid for-gGzday,&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: Nc, N <. )
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1
2
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MAW t
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.
Micant's si ature
C A Mi6al's signature
\\ " j".,ol\C `91�11'1
Issuing date
Expiration date
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