General Permits (7343)

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CERTIFICATION OF EXEMPTION01,
FROM REQUIRING A CAMA PERMIT pave-. 4±- t/
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 15 NCAC Subchapter 7K .0203.
Applicant Name tnLii' f� k7l t Iti i'
Address i _IsL4S:� [- , .>
City S77
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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Phone Number 0 �! �b f
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for g0 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
j your obtaining any other State, Federal, or Local authorization.
SKETCH e1¢ �, i (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.
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Applicant's raature
CAMA Off icial'wsigna ure
Issuing date
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Attachment: 15 North Carolina Administrative Code 7K .0203

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MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PERMITTEE
LOCATION:
PHONE: ��J
DATE OF INSPECTION
PERNIIT #
FIELD REP. "
DATE REPORTEDLY COMPLETE:
(�rx -JL;l
IV x
1) Do thq4ftusured dimensions of the development differ from those indicated in the permit and workplat?
YES/ O [c cle one].
COMMENT:
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? YES/NO [circle one]
COMMENT:
3) FUTURE MO RING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? YEI O�circle one].
COMMENT: