General Permits (6542)

-71
CERTIFICATION OF EXEMPTION
�- FROM REQUIRING A CAMA PERMIT
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as authorized by the State of North Carolina, j
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission i
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203. ? xi
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Applicant Name -r\ F-'►jfiij -r. r� d ��`%L ot� Phone Number �: �:� "r(r- 7 G31Z
Address C,, i `1 flu tJG,Q `:mx) k G C "�b P + ✓F
City �;a.= L'..tAV - „J
Project Location (County, State Road, Water Bo
V"iW(t'0 Si -of rI Suv 0�v0 iiv C' e.t
F, etc.) 15 Ems,
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State ► J (_
Zip Z 7 fir �
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Type and Dimensions of Project �'F �' 2 z' �� ��.��'�� t�'�r l�r�l x s �1 r� ��� s?-c- n�
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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- NGA•C._7K...0203. 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.
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SKETCH (SCALE: )
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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
t%MAJicial's signature
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Issuing date
Expiration date
Attachment: -15 North-Carelina Administrative -Code 7K .0203_.