General Permits (7742)

CERTIFICATION OF EXEMPTI r
-Y _
FROM REQUIRING A CAMAI PER IT, IgCI. i
as authorized b the State of North Carolina, �.
Y
Depprtment of Environment, Health, and Natural Resources.and t bastal Re ou L ssiaa�
in an area of a iro a taI concern pursuant tb,�5-N* G-A"ubehapter'iC-42 MORE AJACEME
_ 1' HEAD
Applicant Name Phone Number1
Address
-- - ZipoCity 1t
Project Location (County, State Road, Water Body, etc.) A f . 4k S(Z i i -'
a
Type and Dimensions of Project i� c't1ic; Lc �:� = q, � `c, launek t?,ram r
E ri (A
a
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-•NGAG-�k-G283-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-days4rGm thedeWGf-issuenee. Following expiration,
a re-examination of the project and project site maybe necessary
to continue this certification.
I SKETCH (SCALE: ) I
........................... ................ pit
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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.
(tA C� �Gt L-'lr�Gr,� + �11 1 i ll n 'a4Xtc� �i�r•,.�r1et3
/ '.,Applicant's signature
�A A Official' sig ature s
Issuing date
�2 000
Expiration date
-Attachment:-15 lNto 3

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