General Permits (3024)

CERTIFICATION OF EXEMPTIONS
-'1r- FROM REQUIRING A CAMA PERMIT i' #)i
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources'Zo L.
in an area of environmental concern pursuant to-t5-NC-­AC Subellapter 7K :0203 �""�`° ' '"""""g�'� ••«3A�►u�.
Applicant Name
Address 1 0410�v.r
City
Project Location (County, State Road, Water Body, etc.)
State
Phone Number a\R `)-� > '` 1
Type and Dimensions of Project
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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- NCAG=71<-%0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip --17
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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 been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
,A71icant's signature
CAMA Official's signature
Issuing date
=A —S \ ":� \CiC-��
Expiration date
ac mehl: 1.5"North Carolina Administrative Code 7K .0203