General Permits (3031)

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CERTIFICATION OF EXEMPTION
:.FROM REQUIRING A CAMA PERMIT;
as authorized by the State of North Carolina,
-
Depidment of Natural Resources and Community Development and the Coastal Resources Commission
in an
nnuarea of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name �
/._ Phone Number Address
City i-? In x,. r F State - !, ,: , - Zip -2
Project Location (County, State Road, Walter Body, etc.)
1 '1 J
Type and Dimensions of Project 4 V
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.
4 i a „
1 �
This certification of exemption from requiring a CAMA permit is
valid for 60 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 = c L-„ , fo rx t (P(SCALE: A--) A�� )
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f
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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203