HomeMy WebLinkAboutGP EX - Elizabeth City Shrine ClubCERTIFICATION OF EXEMPTION vv�
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of ,r�
environmental concern pursuant to 15 NCAC Subchapter 7K or NCGS 113A-103 (5) (b) (6)_V.
ApplicantName 1,1n6e+a 61y Skf-;„e Ciul Phone Number V) 2-339— TWI
Addrpcc I 2 L L\ v„ -i-; 11 V R J
City
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Project Location (County, State Road, Water Body, etc.) t. `' •° d,%!y J
Zip 2 792 1
C d /V C 7 92- !
Type and Dimensions of Project + { ! [ rx, s
L2.93 ulkt,e.J approved (y,ekF;jl in er,jed fNn(
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The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit
described above is hereby certified as exempt from the is valid for 120 days from the date of issuance. Following
CAMA permit requirements. This exemption to CAMA expiration, a re-examination of the projectand projectsite may
permit requirements does not alleviate the necessity of be necessary to continue this certification.
your obtaining any other State, Federal, or Local
authorization.
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Any person who proceeds with a development without the con-
sent of a CAMA official under 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 the
applicant will abide by the conditions of this exemption.
Applicant's signature
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CAMA Official's signature
10 / ),1 1-L 4 -z- i j 4 / Z- 5-
Issuing date Expiration Date
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