General Permits (2639)

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CERTIFICATION OF EXEMPTIOND
FROM REQUIRING A CAMA PERMIT tV0V
as authorized by the State of North Carolina, 0 1 Z�1
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter-7-K :fl203 " G "), 1 'i }/y-�
CITY
Applicant Name Phone Number f� �� �'� --'F 4v
Address
City State Zip
Project Location (County, State Road, Water Body, etc.) i
Type and Dimensions of Project
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 ccrtification 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.
SKETCH (SCALE: j )
1 _
II�� � � 1_ r t�. (f �'� l 1, \ . i,,! c � •.�f h )
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 beernobtained from_adjacent
landowners certifying that they have- no objections -. to - the
proposed work.
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Applicant's s�gature
CAMA Official's signature
Issuing date
Expiration date
Attachment`lS No"rih Carolina A-i'mtnistr`afive Code-7K.02o3