General Permits (2765)

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Applicant Name
Address
City
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 NGibeftaptEv-7% 3. /V C
Phone Number
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 dbds'not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip 7r;,Wi
This certification of exemption from requiring a CAMA permit is
valid for go 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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A r.nrenn who nrnroorie with a rlavalnnmont without the mn-
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) awritteci.statement has been -obtained from -adjacent
landowners certifying- that they haves no -objections -to the--
.proposed work. -
Applicant's signature
CAM Official's sign ture
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Issuing date /
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Expiration date
Attachment*; 15- North -Caroaina-AdministratWCo e"7K'0203`"—