General Permits (3732)

CERTIFICATION OF EXE~MPTIOEAL
FROM REQUIRING A CAMA PERMIT 97
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resoi�w��o,�wwM�MA
in an area of environmental concern pursuant to f5:NCAC Subchapter 7K .G203.
Applicant Name Phone Number
Address
City State t-4_ zip 1
Project Location (County,,State Road, Water Body, etc.) 4"�� �:�, a ?� �•," v-
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.
. 1Y V ..— r..,.,.,,, ..._......... --- ---- ---
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.
f
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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 1.5 North Carolina Administrative Code 7K .0203