General Permits (2804)

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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
in an area of environmental concern pursuant to 15 NCAGSubchapter 7K .0203. �7
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Applicant Name f` 1 '' 6'9 d ��� t �.!� Phone Number
Address
City State { t ," Zips
Project Location (County, State Road, Water Body, etc.) />',2
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 does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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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 obtained from adjacergt-
landowners certifying that they have no objections- to the
proposed work.
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.
CAMA Official's signature
Z
Issuing date /
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203--•