General Permits (80)

CERT FICATION OF EXEMPTION W1 9
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern. pu.rsuant4e��5_NCAG-S4bchapter;.7-,1� 02.03.
Applicant Name !S�,, //, Phone Number ?;23- VKS"�/
Address %� i iJ�e lcn ,-,d
City State Xt�_ Zi �Pd_ir74
Project Location (County, State Road, Water Body, etc.) 1.�/o cif ca...
41
Type and Dimensions of Project ) le + AACI_
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
/«nr-
This ccrtifidation of exemption from requiring a CAMA permit is
valid for.9* ays 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: AV/ )
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Ab
C�71 l�ir'17-
dedam'
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.
Applicant's signature
CAMA Official's signature
'! Psr 96
Issuing date
�1-3I- `>i
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203