General Permits (3240)

9
CERT.IFlCTiON,OF EXEMPTION J�
FROM REQUIRING A CAMA PERMIT P Q �J
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,NCAG-Subch4apter 71K0203;
Applicant Name
Address C).
City 14W /ac/,
Project Location (County, State Road,
Type and Dimensions of P
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement,pursuar � 15TNCAC„.�iC:A293. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number (IV 7- 412,93
This tfiption from requiring a CAMA permit is
valid fop9A-days.from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
C - ,' , , ) /''.
I SKETCH (SCALE:
c
^av
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) aw.ritterastatement has .been obtained from,adjacent
landowners.._ certifying- that they. -have no objections_:to.. the
propos-ed-work.
Applicant's signature
CAMA Official's signaure
//,1iffa
Issuing date
)/Y/ /ql -
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203