General Permits (3175)

Y 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 ! f I '}+- .P/� -" �' Phone Number
Address , 3 al t
City / r State . A� T < Zip
Location o nty, St to Road Water Body, etc.) g o "A
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T(rpe and Dimensions of Projects o /Or-u -*7- a -%
e?kThe proposed project 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.
SKETCH ,' 44 P71,) ,r i4
f
Any person who prod;�r'�itl7 evel pmbnt wit - t the con-
sent of a CAMA offf ar u ak�rr `option that the
development is exe�pteii, will be in violation of the LAMA 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.
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This certification of exemption from requiring a CAMA permit is
valid for 90 days from,the date of issuance. Following expiration',
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE: )
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CAMA Official's signature 61 t
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203