General Permits (6635)

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
r� in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203. � • , IVrr'i i 3;. b) (S)
Applicant Name Lv v) % tKA a4 h S
Address i L4LQi n
City p
Project Location (County, State Road, Water Body, etc.) 1
Type and Dimensions of Project L a iT :> t q Q I" V^•,-
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 N'CACj7K :0203:`Thi's'exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number (ZS
State Zip /614 y
SUP Lose (oL SR 13—
D ° __ r ­r:> ,
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:
I
i4 I V; ' fn A rJ S
A, who n nnooiic with n r°ovolnnmont without tha rrnn-
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.
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4 1
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Pi k Dr AA_k
Applicant's signature /
CAMA Official's slgn�ture -F
Issuing date
Expi`ration;date
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Attachment: 15 North Carolina Administrative Code 7K .0203