General Permits (3428)

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CERTIFICATION OF EXEMPTION
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FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commissio
in an area of environmental concern pursuant to 1:5--INIC G Subcftapter-7K M03:
Applicant Name ra�i �S )�cc�� Phone Number
Address
City ; ::,v ., C_ '4 State` x Zi'dt� ki "r,
Project Location (County, State Road, Water Body, yetc.)
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Type and Dimensions of Project
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-: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-ex4mtnati6n of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: � ) I
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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 , a ure",
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North-,Mdfiha Ad- iinis"trativi�o3e`7K .0203