General Permits (2079)

O
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 C mm}'s�si �, 57
in an area of environmental concern pursuant to 15 NC •ubchapter 7K .0203."-_ jt%��s 1r1 '�p7
Applicant Name f r c7ee 'A'1/ Phone Number e— 5 1 '"�` , �'�/
Address J
City v
Project Location (Cou
State Road, Water Body, etc.)
State
Type and Dimensions of Project z;,/ /i T
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 requir"enents does not alleviate the necessity of
your obtaining arfyi other State, Federal, or Local authorization.
FSKETCH
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.
Zip
This certification of exemption from requiring a CAMA permit is
valid for g0 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:
Applicant's signdtureJ
CAMA Official's signature
Issuing date /
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203