General Permits (3731)

CERTIFICATION OF EXEM PTIOnir'
FROM REQUIRING A CAMA PERMIT APR 1 0 7 s,
as authorized by the State of North Carolina, 7-
Department of Environment, Health, and Natural Resources and the Coastal Res
in an area of environmental concern pursuant to IFMAC--Sub-chapter 7K">02©3. ••"'••'•••••••••••!��
Applicant Name 4, U(-.,Z\ Phone Number
Address W.* �
City State zip
Project Location (County, State Road, Water Body, etc.) t.
Q71—
Type and Dimensions of Project��-�._ t�-j•,-� G �_�. :�,
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-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: ;,., )
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.
c. C `
Applicant's signature
CAMA Offici�al's signature
-
Issuing date
Expiration date
Attachment:15 North Carolina Administrative Code 7K .0203