General Permits (1966)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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 1.5 NCAGSubchapter-7K-,Q2 & IV 65- Ili
Applicant Name ;r' ! I t'frh.4Phone Number
Address f ' -+,-
City State' Zip
Project Location (County, State Road, Water Body, etc.) %
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Type and Dimensions of Project / ,/e<
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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.yThis eXpM on to a re-examination of the project and project site may be necessary
CAMApermit requirements- does not. alleviate the necessity_of to continue this certification.
your obtaiAing any.other State Federal or.Local authorization
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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 h-ave-• no --objections- to- the
-proposed-work.
Applicant's signature n
CAMA Official's signature
Issuing date
Expiration date
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Attachment: t5 North Carolina Administrative Code 7.K..0203--