General Permits (2092)

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 Commissiop
in an
area of environmental concern pursuant to 1-&.NGAe-Subchapter 7K-.0203- xlei%' , -Y le"17 :5
Applicant N me Phone Number 05t"""
Address
City State zip
Project Location (County, State Road, Water Body, etc.) w ;o•'� V_ "tee
f
w'
Type and Dimensions of Project ` e' r`
The proposed project to be located and constructed as described
above is hereby certified as exempt from the,CAMA permit re-
quirement pursuant to 1S NqAC 7K-..0203.-iThis exemption to
CAMA permit requirements -does not alleviate the necessity of
your obtaining any other
State, Federal, or Local authorriization
SKETCH
6w, 41114�1 r4e/
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)-awritten statement has beeTvobtained'fr'om aiilacenf
landowners- certifying that they, have --no --objections-'tb-'tKw
proposed work. -
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: .,�
Issuing date' %
Expiration date
Attachment:..1.5 North Carolina -Administrative Code 7K-.0203