General Permits (1724)

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Y CERTIFICATION OF EXEMPTI Q I,
FROM REQUIRING A CAMA PERMIT OCT 0 5 19U..3
as authorized by the State of North Carolina, ' u -Jo- m d
Department of Environment, Health, and Natural Resources and the Coastal Res u� rces Commission _______.
Applicant Name
Address
City
Project Location
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
$6 A-4 ,
J rr%At,� Sr, &4N � Phone Number `7c73 �t7 d OC- l
State Road(llVater Body, etc.)
Type and Dimensions of`.�roject
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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.
State _
, !
Zip 7 -?:5 2E�-
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.
I SKETCH (SCALE: >" 7,1-iD' ) I
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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
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.
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Applicant's signature
CAMA Official's signature{ . f —9 - -
Issuing date
r—
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203