General Permits (3525)

Applicant Name _
Address
City
Project Location
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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 NCAC Subchapter 7K .0203.
�. Phone Number
State Road, Water Body, etc.)
Type and Dimensions of Project
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The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15-NCAC.7K=:0243. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of - to continue this certification.
your obtaining any other State, Federal, or Local authorization. /
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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 writtenstatement- has been obtained from -adjacent
landowners certifying that they have no -.objections to the
proposed work.
' V I Y/t�L iTti
Applicant's signature
CAMA Official's signature
Issuing dafe
Expiration date
Attachment: 15 North -Carolina -Administrative Code 7K .0203