General Permits (2005)

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Applicant Name
Address f
City
Project Location
CERTIFICATION OF EXEMPTION RECEIVED
FROM REQUIRING A CAMA PERMIT JUL
as authorized by the State of North Carolina, 4 Z012
Department of Environment, Health, and Natural Resources and the Coastal Resorrces Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K D M .r�ru
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Number t1
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, State
Water Body, etc.)
State
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Type and Dimensions of Project L kk o t ry o A
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 alfeviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
l
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.
(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) a-written•statement has been-obtained-frorrf adjaVent
landowners certifying that -they have --no objections- to, -the
proposed work.
'Applicant's signature
1
CAMA Official's sign t re
Issuing date
Expiration date
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Attachment: 15 North Carolina Administrative Code 7K .0203