General Permits (973)

CERTIFICATION OF EXEMP O
PL FROM REQUIRING A CAMA PERMIT E
as authorized by the State of North Carolina, W
'l
Department of Environment, Health, and Natural Resources and the Coastal Resources n v
i``nn�an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name 9f%-c` ,W a, rs
Address G
City
Project Locati
, State Road
Type and Dimensions o�Project
Body, etc.)
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
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-
plicantY2)
d-artd-will abide by the conditions of thisexemp-
tion, aritten statement has been obtained from adjaclandortifying that they have no objections to the
roposed work.
Phone Number
State A/C Zip _ 5
e3/9 nr/tr..1
���a
." i,
This ce=da
emption from requiring a CAMA permit is
va ' orhe date of issuance. Following expiration,
a r project and project site may be necessary
to continue this certification.
(SCALE: /{/) I
iAppucant-s signature n((�
HcyQ (/
CAMA Officcial's sign lure
'L2 K
Issuing date
2� Noo-eh,kv jqQS
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203