General Permits (2643)

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-RECF,IVEIy ,
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
s 20
11
as authorized by the State of North Carolina, DC
Department of Environment, Health, and Natural Resources and the Coastal*(Wd'iloges Commission
i in an area of environmental concern pursuant to 15 NCAC Subchapter 7K -.0203. 6. � i '>
Applicant Name f ��s �,4 1. �� `t �.• �< Phone Number a 116
Address ; ; : I,�.;
City State c Zip
Project Location (County, State Road, Water Body, etc.) i v << J ;
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Type and Dimensions of Project J41r !► e ri ire p� f. .f , ,:, ,, .
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.
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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.
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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 obtained from adjacernt�- -
landowners certifying that -they .have no -objections- to the
proposed work.
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Official's signature
Issuing date
Expiration date
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Attachment:-15 North-Carolina_.Admin'tstrative. Coda 71K-:02032