General Permits (2142)

v
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 ' f� 1 `r
in an area of environmental ncern pursuant to 1EMCAC-�Subehapt� J 3 -�
Applicant Name Phone Number 13
Address'
City Ln;�r �;.a;r: F ;.s•� State zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Projec4. dar'�
.:Ji 104. .
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 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.
I SKETCH (SCALE: )
r'
r
f'
1?wi�l�x > f -r r % : s�i.�l'rX f✓�
tell
� .+. J,a,, �,,1 l.: ?'I! /f /�� J r,�/'i'!�7� �.� /''-7ae`.f"t'''••`v''•*s".� ��. ��f� •
Anti nnrenn ve,hn nrneeorla with a dPvP1nnmPnt 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 (Z),awritten statement has been obtained from -adjacent
landowners certifying that they have no objections - to the
proposed work.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K-,0203