General Permits (3273)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT p
as authorized by the State of North Carolina, (' Of/
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter7K .0203.
Applicant Name ,/e�°f� `�U���✓ �i
Address = j 'R'-i,r�, I:�-. �� t•,�.
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project �' �:x• - ,
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 71K-:0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
PhoneNumber
State Zip
This certification of exemption from requiring a CAMA permit is
valid for Wdays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: .��, _ ) I
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.
sign
CAMA Official's signature
i
Issuing date
e. t
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203