General Permits (2000)

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Applicant Name
Address
City '
Project.Location
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..NCAC..Subchapter 7K 0203; /Pe
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Phone Number
unty, State Road, Water Body, etc.)
State
Type and Dimensions of Project ,Z iPf,/,",ti f'7/ r'/rr,5
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 NCAC7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip Z,Plf`�'
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.
SKETCH (SCALE: )
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Any person wno proceeas wnn a aevewPmern wiuiUui uic wn-
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 obfaiiied from adjacent
landowners ceriiifying that they have no objections to the
proposed work.a l-
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K_.02Q _