General Permits (7682)

-11!-
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 Com,-mission�s�
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name " 4l OW& G :S Phone Number
Address 6
City I ACM State Zip
Project Location (County„.State Road, Water golly, etc.) } ea I w7m 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 1titl7AEt 020. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local au;ho�izyztiQ�n
K)C.Ca5 13 h _) J3{{/,
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: ; )
A
IV
_ = aV�C - r
,
TIE
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 �wltr'Af�hasabeenststafnedfit%ti
(a�dnV'vii•Fertifyira�'th'at�-ih'€�`�ti'�v�`�b�tions�•to tk�e
,.WDpGsed-work.
f
RCC1
Apo icalt' igrtature ;
CAMA icial's signature
Issuing d t
Expiration dtite
Affechment: 15 North Carolina Administrative Code 7K .0203