General Permits (8223)

• � RECEIVED
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CERTIFICATION OF EXEMPTIONA 8 201,
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FROM REQUIRING A CAMA PERMIT
DCM_MIM C
as authorized by the State of North Carolina, 17Y
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 16NCAC c ap,W K ,.Q /}C 6 5 d
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Applicant Name tfY P f,C._, J'"�' �tP,y�+ �� `Phone Number'
Address PP6.1 e'` i
City .' , e'•' ; .. -r ':..• State zip Z%=
Project. Location (County, State Road, Water Body, etc.) �t' !�
eft/ IS,!` h�' -,
Type and Dimensions of Pro
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.NGAC-7K •:0203. Jhis 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 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH -_ , (SCALE: f\1 J � ) I
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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.
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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 Iobjections to the
proposed work.
P, V
Applicant's signature
CAMA Off icial'l's sig ature
Issuing date
Expiration date
C
/t
I
Attachment: 15 North Carolina Administrative Code 7K .0203
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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.
�v��✓ Sly. 'i` Ae
lk
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 Iobjections to the
proposed work.
P, V
Applicant's signature
CAMA Off icial'l's sig ature
Issuing date
Expiration date
C
/t
I
Attachment: 15 North Carolina Administrative Code 7K .0203
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