General Permits (3237)

CERTIFICATION-10F EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, " (A
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission A)
in an area of environmental concern pursuant to1.5rNCAC Subchapter -7K.0203.
Applicant Name
Address
Citv
Project Location (County, State Road, Water Body, etc.)
Phone Number F$$3— 3L-J'7
State W C
Type and Dimensions of Project C
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 -NCAG 7K--.0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
zip'e' i ) 7"'
This certification -of -exemption from requiring a CAMA permit is
valid forM-days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
ISKETCH (SCALE: ) I
40,
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.
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Applicant's signature
CAMA Official's sign re
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K.0203