General Permits (2713)

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CERTIFICATION OF EXEMPTIQNE j r�r,,;,�Jt.
FROM REQUIRING A CAMA PERMIT 1 2011 ) �,/) ► 4 0
as authorized by the State of North Carolina, 5EP 2
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.
DCM-MHD CITY -7
Applicant Name f "1 f -f Phone Number
Address nA ;,1, -r r
City State Zip
Project Location (County, State Road, Water Body, etc.)
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Type and Dimensions of Project � 4 ,� r ;,- z :1.:. , : i < !J C ! k % ( <' r
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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.
SKETCH
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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.
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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 O 2 8Lwritten-statementhasbeendbtainedfrdmad1jacent
landowners certifying that they have no objections to the ` _--
proposed work.
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Appflcani"s slgnAmwe. L /
CAMA Official's signature
Issuing date '
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Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203