General Permits (3231)

4
Applicant Name
Address A
City
Project Locatior
frfIUI T
CE.R:TIFICATiN 0,17 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 pursua­M"a45-NCA0 Subchapte-ra W.0203.
Ir J, State
(County, State Road, Water Body, etc.) K6 7 ,
Phone Number i`e,-6 "7G
Type and Dimensions of Project
7vp;- c:
The proposed project to be located and constructed as described This•ee*f"tiaa of -exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90-d'ays from the date of issuance. Following expiration,
quirement ptirsrrattt�-tor1�.NGAC`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.
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.
LAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203