General Permits (3004)

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 NCAG-Subchapter 7K .0203.
Applicant Name Phone Numberf<-�
Address
City State .$J6 Zip
Project Location (County, State Road, Water Body, etc.)'C
Type and Dimensions of Project w_ - ; �� %.: t' �t.r/ .d, fir" k-20
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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 for80'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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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)-awritterrstatement has been obtained from adjacent
landowners -•certifying -that -they- have -no--objections--to- the -
proposed ,work.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
1
Attachment: 15 North Carolina Administrative Code 7K .0203