General Permits (211)

O
Applicant Name
Address
City �,4y
Project Location
CERTI171 = T1ON-:10F EXEMPTION cW
FROM REQUIRING A CAMA PERMIT Jvll� /' r1
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 purstia-nt-to-TF-N()sAC-Subchapter--7K-,0203. .
Phone Number J (IC c)t //
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement puxs tt-to-IS-N rA6 7-K 020S: This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
/-ip f X S ".;
j c ,-
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.
C _ Cc-� %PTd
I SKETCH (SCALE: . ��, ;,_. )
Jo r <-:.�L � �; -� Stir " �, o�j� j ; i � � • /C� � • ,�
,. Al vJ I .
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.
I
Applicant's signatur%--
CAMA Official's sign ure
9-, 0- 46
Issuing date
_2 f 3
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203