General Permits (2676)

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Applicant Name
Address
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RECEIVED
CERTIFICATION OF EXEMPTION"
V 0 3 2011
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, -Health; and Natural Resources and the Coastal ResouCW&T*.ion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203. Ifz c2
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City I,, ; P"
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project I?G )r1 lit C--f
AA
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.
State Zip 7`7`1 '+
;,
This certification of exemption from requiring a CAMA permit is
valid for Wday's from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification. r'
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7�-
117
J yr
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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 beenvbtainedfrom-adjacent
landowners. ceri ffying_. that they haue_—ao._.obje4o,ns.-.ta.the
proposed-wor{ -. ----
Applicant's signature, T t
CAMA Official's signature
Issuing data
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203