General Permits (3091)

CERTIFICATION -OF EXEMPTION
FROM REQUIRING A CAMA PERMIT n�,tiW_,��
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.NGAC Subchapter 74<-0203.
Applicant Name
Address ' - -
City '
Project Location (County, State Road,"_Water Body, etc.) _
State
Phone Number
Type and Dimensions of Project,
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.
Zipv.C/ r
, 'r : ` This certification of exemption from requiring a CAMA permit is
valid for-90days 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: ;. ) I
:!�, 1�,.✓`t 'fir. ,.(..y �..F±{�.l% +�j)l��.ti.. �s
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.
/ 09,14 AY1J 7
7
.r
Applicant's signature I"
r
CAMA Official's signatur9 4
Issuing date 1t
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203