General Permits (3671)

O
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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as authorized by the State of North Carolina, Ad
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area ofn�o ,environme ttal concern pursua15 NCAC Subchapter 7K .0203.
°I I � n � i 11 .-
Applicant Name
Addres C
City
Project Locatio _Cotjn;y, State Road,
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.
Phone Number Z_ 3 - 52-S
Zip
This certification of exemption from requiring a CAMA permit is
valid for-ga4ays 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: k r t�-� _ )
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.
CAMA Officia�l',s signature
R— l q lv
Issuing date
-7- iC9-9 i
Expiration date
Attachment: 15 North Carolina Administrative Code_7_K_0203
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