General Permits (2803)

-Y.
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
k 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-S•ubchapter.7K .0203_,., S. 1l3,4_It]3(5_V16)(.r
Applicant Name
Address =
City
Project Location (County, State Road, Water Body, etc.)
Phone Number;aja) a5d --a r x(.
State Zip d J qs g
type and Dimensions of Project = IUU h.) s I
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.
This certification of exemption from requiring a CAMA permit is
valid for 9Q 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
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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 been obtainedlrom-adjacent
landowners certifying ---that they have no objections—lo`-fhe
proposed -work.
X t
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
-AttaCfiment:"I.5,North-Carbltri'a'Administrative-code 7K-.0203