General Permits (3079)

v
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 NCAC Subchapter 7K .0203.
Applicant Name r' � :�t� A il� +�-o 3 W, � tk 3 Phone Number f
Address
City x :.�,- State Zip
Project Location (County, State Road, Water Body, etc.).
Type and Dimensions of Project .3 91 ! r sR ��"{tom y 2,0 / Iw ,., 6J � _.-
Ef' ! T r. ; �!? �'.i is r �• _ct a6 �,,. `.` P f" ✓i r I !.r�iv' fi /, 4
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The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
SKETCH (SCALE:
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"7 Ll
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Any person who proceeds with a development,withlput the n-
sent of a CAMA official and r,tt i? Fni4taken assumption tha.the
development is exempted, ilein violation of the CAMA,if there
is a subsequent determinatic hat;•,9ipermit was,rggdired fo�the
development.
� a1
The applicant certifies by si ap
plicant has read and W"dW0M&TA *,go np-
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