General Permits (2749)

CERTIFICATION OF EXEMPTION R,EfVE'D
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FROM REQUIRING A CAMA PERMIT
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as authorized by the State of North Carolina,
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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.
Applicant Name
Phone Number
'as-�1 �� �- I
Address a' to
City
State
Zip`
Project Location (County,
State Road, Water Body, etc.) ,�._
A,i1 i, t;
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-N.CAC..7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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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: `) I
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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-wittenstatemerrrhas been obfairied from'adjacent
landowners-certifymg -that-they-have--no objections to the
propased.work.... ___
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licant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203