General Permits (763)

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CERTIFICATION OF EXEN
FROM REQUIRING A CAMA PERMIT 6
as authorized by the State of North Carolina, LPO 0-%,, °ta,,
Department of Environment, Health, and Natural Resources and the
in an area of environmental concern pursuant to 15 NCAC Subchap
Applicant Name r G 1
Address u
City StatE
Project Location (Co nty, tate Roayd, Water Body, etc.) ►,
Type and Dimensions,of Pro
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification. 4>%-c r
your obtaining any other State, Federal, or L99al authorization. U,
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
A plicant's signature
development is exempted, will be in violation of the CAMA if there
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is a subsequent determination that a permit was required for the
C l's signature
development.
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The applicant certifies by signing this exemption that (1) the ap-
Issuing date
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
Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203