General Permits (604)

"MC N� 9 y
CERTIFICATION OF EXEMPTION
_Y FROM REQUIRING A CAMA PERMIT `7_5 \ i\,\ lJ l`2��9�1 39
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 pursuant to 15 NCAC Subchapter-7K .0203.
Applicant Name c j'G' :3+�� =��c,, Phone Numberti�;.��
Address 1A \ ` \ Go -As -kV,
City �.:�.:� ^� State N - Zip aQ X1u+
Project Location (County, State Road, Water Body, etc.)' ,�:4 ` '' ito
�-�ti �'4 C� � v � � �:L '� i.. •--v'• f o.: w' vk-•z
Type and Dimensions of Project V1,
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 115,14 AC 7K--• 0205. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
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.
This certification of exemption from requiring a CAMA permit is
valid for 10:,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:
,
�'pplicant's'signature "
C Official's signature
Issuing date
-1-'\. � 4�3( a \';9 �
Expiration date
Go,'I'
10`1
Attachment-1-15 North Carolina -Administrative Code 7K:0203