General Permits (2523)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT J
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' as authorized by the State of North Carolina, / =
E Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter-7K•.0203... ,SIC" � �
Applicant Name
Address
City t .
Project Location (gounty,
- J u-
ad, Water Body, etc.)
Type and Dimensions ofXroject 12_e, Li
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA pe mit 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.
N_
Phone Number u �D, �jr Y
_ State / f�
zip
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
io cor roue this certification.
SKETCH (SCALE:; j )
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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 written statement has-been obtainedfrom-adOEont
landowners, certifying that they have no- obje!�fions-_to: the
proposed work.
Y
Applicant'_S signature
CAM signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 71<.0203