General Permits (8004)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT /, ..
as authorized by the State of North Carolina, '1
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NGAC8ubchapter7K-.0203--
Applicant Name A 11)tQj<is Phone Number( .2 3 _ y'
Address �+ Y I i,�r. /` i . fti"L -. T: %' L i
City State - zip .1
Project Location (County, State Road, Water Body, etc.) � �i 7- Ir
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Type and Dimensions of Project r ,rf r�. :�i-rc ri',/►=
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--NCAC 7-K .G203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
5 e"
This ccrtifi�ation of exemption from requiring a CAMA permit is
valid for 96 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: -- )
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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 staternent.has.been obtained from.adjacent
landowners -certifying--that - they- have -no-objections. to. the
proposed work.
Applicant's signature
CAMA Official's signature
Issuing date
i ic•' U' i41 r"�— �� /,(i4 Y 1
Expiration date U---
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