General Permits (2796)

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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 r
in an area of environmental concern pursuant to is X9i? pter7K=0203, .i1, e_,- ; -
Applicant Name Phone Number
Address t
City
Project Locatigqn C u
nty, State Road, Water Body, etc.)
I ype ana uimensionS oT vrgjeci
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.UCAC 7K .0203..This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
/
State
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.
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 statement -has beerrobtained-from adjacent
landowners -certifying -that they have- no' objection"s rd-- the
,,proposed'w&k.
Applicant's s�gnatvre +
CAMA Official's signature
Issuing date
Expiration date
-F)
Attachment: 1.5 North Carolina-Administrative-Code7K.0203