General Permits (2132)

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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 /(Ae✓S 1�z'�'�c1Cb7t'�"i
Applicant Name
Address W '
City yt
Project Location (County, State Road, Water Body, etc.)
Phone Number .- ,/,,, ,
State Zip
Type and Dimensions of Project '�r� � � � � .� �.tl
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to N.;7.kS�S22Q_3;'This exemption to
CAMA permit requirerjients does not alleviate the necessity of
your obtaining any other State, Federal, or Local uthorization.
SKETCH
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
E` landowners certifying that they have no objections to the
proposed work.
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 signatur$
CAMA Official's signature
issuing bite
Expiration ddte
Attachment: 15 North Carolina Administrative Code 7K .0203