General Permits (409)

w
I.
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, ��d/
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name r-° sc�y� y , _kr Phone Number ! d- o
Address J Ye- r 4.
City f State Zip l" S
Project Location (County, State Road, Water Body, etc.)
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 pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH _.
o
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.
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.
(SCALE: )
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

M16ad 1 "log 3
.�
_ ecv� �Rfs�rf to N 1 1 /rya P _ C'�2e� Oo ,'jZj;�4(
IV m j e.�' L'a �� -f ��E 2oa1.57-�Wio,c)
,6y ;Sutkdeacl!g fiti
r
9 - 1iAmme,P.
_emu.
Nk

ff-1116 �t�g
We- lq8e OZt]AIICA 4god- Ad' o.lovoVI
SQQP- 7-Stn Anil ?-lilt e OR P- levle-7. dmLA��-
Ile- /Vo Ozje��Iolq
6y
Mll.
I
. - t #---- --

P 7, .
qt,z%�� ^ t
Lf
��-
}

't
_
� i
��g'n:'1t�d'r+
;4:a
A
r�
i(
� �'
,llrJ
per

�, 30- y3