General Permits (3565)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
j
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.
Applicant Name LT_
Address
City
Project Location (County, State Road, Water Body, etc.)
State
Phone Number li'7 3 - 6, Kam: 5
c
Type and Dimensions of Project ! 4Eii- i 'i;:r i -0— AIL i t-, LArl L2,
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to tS,,,R AQ;7V�ZQ2 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
This certification of exemption from requiring a CAMA permit is
valid foY-90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
Gf�S !1 A — Ba.:
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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-wrfttartstatsmGnt°hasb'eant obtained44DM,-,adjacent
lgirrdawnerzs certifying -that they have -no <-objections-ta the
proposed,work;
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15--North •Carolina--Administrativa'Goc4e 71<,0203