General Permits (2004)

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CERTIFICATION OF EXEMPTION -l/
(:D7 FROM REQUIRING A CAMA PERMIT 8 2011
as authorized by the State of North Carolina, M� 1
Department of Environment, Health, and Natural Resources and the Coastal Resources Wo-r MP Y
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0103.
Applicant Name w Phone Number
Address 'S E
City State M r Zip $
Project Location (C unty, State Road, Wat Body, etc.
OR 1 ' I If-2 !S v'� f "`
i
Type and Dimension of P Qject eALI
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 .0�03. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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.
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SKETCH (SCALE:
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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) awrit+en-stateFaeet-has«beenobtainedfmmadjaeent-
-4aadaw,ners...csagying..-that_-.they .have..-xao--objections-to--the-
--Wopesed-wer+r.
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CAMA OfficiaTA st ure
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Issuing date bqla
Expiration date
A*aehment: 15 North Carolina Administrative Code 7K .0203�