General Permits (2356)

CERTIFICATION OF EXEMPTI$,
FROM REQUIRING A CAMA PERMIT ► AR 2 7
as authorized by the State of North Carolina, u
Department of Environment, Health, and Natural Resources and the Coastal Re o ►srt� ion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.- """",
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project: I
The proposed project to be located wind constructed as described
above is hereby certified as exempt from Oe CAMA permit re-
quirement pursuant to 15 NCAC 7K .6L03. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
State
Phone Number''
Z
zip Z�
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 proceedls with a development without the con-
sent of a CAMA official umder 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 b!y signing this exemption that (1) the ap-
plicant has read and wild aloide by the conditions of this exemp-
tion, and (2) a written sta ternent has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
Applicant's signature �—
CAMA Official's signature
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Issuing date
ca ` I i; l qqs�
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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