General Permits (2170)

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CERTIFICATION OF EXEMPTIO DECEIVED
FROM REQUIRING A CAMA PERMIT JUN g Z�
as authorized by the State of North Carolina, j�
Department of Environment, Health, and Natural Resources and the Coastal Resiburces Commission
in an area of environmental concern pursuant to 15-NGAE,Subehapter--7-K-.0203f
D�M'MND
Applicant Name ',�ljty1't r//%i{jr1
Address
City r.
Project Location, (County, State Road, WateryyB�od, etc.)
State
d•rs•
Phone Number 7
Type and Dimensions of Project t_ fy- l- 7!,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--NGAG-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.
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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-writte n-st ate me nt has-beemobtairredfrom'adjacent
landowners certifying that they --have no objections- to -the--
proposed work —
Applicant's ftnature
CAMA Official's signature
Issuing date '
Expiration date
Attachment: 15 North-Garolina Administrati-ve•Gode-7K .020a