General Permits (3426)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT ( S L�;
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 1- NGAG Subehepter 7-K .0203.
Applicant Name M' r �• \� Phone Number.
Address a \
City State V 7ip _1T )"\
Project Location (County, State Road, Water Body, etc.)
Ty. a and Dimensions of Project
�= -v
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1.5 . CAC-7K >0203 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examfnattbh'of the project and project site may be necessary
to continue this certification.
SKETCH i M (SCALE: ` )
.71
---1"71 t l� «a
36
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.
Applicant'&aignature
CAMAC fficial's signature
Issuing date
Expiration date
Attachment: 1-5 -North Carolina Adniinfistrative`Co&e �7K .0203-