General Permits (2777)

-Y
FROM REQUIRING A CA
as authorized by the State of North Carol
Department of Environment, Health, and
in an area of environmental concern pur
Applicant Name :: t� ► tt i
Address i i �.r;»�T O a r;
City
Project Location (County, State Road, Water Body, etc.)
,11i11i 1 ,
CERTIFICATION OF EXEMPTION
ina,
Natural Resources and the Coastal Resources Commission
suant to 15 NCAC Subchapter 7K .0203.
Phone Number 4=+,!t`f
Type and Dimensions of Project ' i yt v, ' ; r 'l r;
i± 4 'L '`j { 1 r'. 4 i i wt 1 �. i � { 1 1 t',11'? it (? m
l: All
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
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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: )
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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-statementhas.b.een obtained-frorn-adjacent
landowners . certifying that..they.. have, -no --objections -ta -the
.proposed work.
s sionature
Asli
CAMA Official's signature
Issuing date
Expiration'date I t
Attachment: 15 North Carolina Administrative Code 7K .0203