General Permits (2972)

CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal
in an area of environmental concern pursuant to 15-NCAG Subchapter 7K .02uj.
Applicant Name Phone Number
Address
City State Zips` .
Project Location (County, State 'load, Water Body, etc.
1 ( Y � Y ) -
Type and Dimensions of Project, y G c,r . s . •�
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.
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 obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
This certification of exemption from requiring a CAMA permit is
valid for Mdays 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
\Ct `1
Issuing date
Expiration date
Attachment: 15 Nor*arofina Admthisfrative Code 7K :0203