General Permits (6960)

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CERT1F1CAT1,0_-N _0'. 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,p' i!ant-4a• a� =, A Sa ap# #4 03
Applicant Name i tft 1. ),4. Phone Number
Address ji < t
City :;: •ice . State iv Zip
Project Location (County, State Road, Water Body, etc.) J.j
Type and Dimensions of Project t•'ta ;r nun<< c ` ;,,- (o 1, LA,,, alien, 41. A10441o^
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement=pursuafi40'tclTlaf?2e3. 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
vali,l igr�90_d'ays.fr6m tFie date tif;iss an e. Follc ng ef60-ration,
a re:-ex'a,miriati n of theprojeo�and project s%i5 maybe necessary
to cpntinua.this.certificatiGn.
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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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App icant's signature
F fir€
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203