General Permits (3689)

i
CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT + ``
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Ra6g gp§
in an area of environmental concern pursuant -to 15-NCAC Subchapter-71< :G2-03
O
Applicant Name
Address_ P •o.
city
Proiect Location
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-NCAe—M 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-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: Fa ;.r• ) I
to
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.
4�k
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attach ment--15 -North Cdrofin a Admiaistrative-Gode 7K-.0-203