General Permits (2779)

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-� CERTIFICATION OF EXEMPTION J
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-02G-4. �; . �, s /1 - i (;
Applicant Name ,, Phone Number
Address 44 I � �t �4
City C State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project i n�
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 NC -AC 7K-.-02d3. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
;.S. 113A (S)ib)(0
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.
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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) awritten statement has been-obtainedfrom-adjacent
landowners certifying--that--they have ­ no objections" to --the
proposed. work.
Applicant's, sib nature .......
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carblina Administrative Code 7K 0203