General Permits (2659)

T12E NC
CERTIFICATION OF EXEMPTION--�--
_,� FROM REQUIRING A CAMA PERMIT RECEIVED
as authorized by the State of North Carolina, ,�,I
Department of Environment, Health, and Natural Resources and the Coastal Resources(Cbr~nr�sioa0�j
in an area of environmental concern pursuant to 15 NCAC Subchapter 71<-.0203.,'_ = i + s(s Yol(f)
Applicant Name h, r ;r I Phone Number-?'wcY
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
r
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 certification of exemption from requiring a CAMA permit is
valid-fbr=Waays 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: )
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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)-awr-itten.statementhas.bEsn.obtainedfrom,adjacent-
landowners -certifying--that---they--have -no -objections.-lo-.the
proposed -work.
Applicant's signature -
CAMA Official's-siV ture
Issuing date
Expiration date
-Attachment": 15 Nbr h a_ rolina_Administ'rafive`Code?K :••OL03-