General Permits (2727)

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Applicant Name
Address
City•
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Project Location
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, _.� , .�.- •_�•----�.»
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .02 -- /i/C 6 - .�/? of /0-7
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State
;Aunty, State Road, Water Body, etc.) A
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Zip
Type and Dimensions of Project 1f.* fg"Vlr ;ti :�2 ' " r`,�'x' ' ;�,o .
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.
SKETCH (SCALE: AVT )
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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 been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
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Applicant's signature L
CAMA-Official's signature
Issuing fdate
/
Expiration date
Attachment: 15 North Carolina Administrative Code -7K .0203.•