General Permits (3790)

17
CERTIFICATION OF EX a
FROM REQUIRING A CAMA PERMIT FED 1 1
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources E astal Resobt+ - • mission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.'°- F4.' e .
Applicant Name i ! i r_ �.��t c Phone Number U -
Address Cr ► t ' : n r ;i cl, (,_
City t -! i! State C, zip '151'
t:
Project Location (County, State Road, Water Body, etc.) 4 r i �;_. 1 t . r�1 0 �
_
Type and Dimensions of Project F
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.
v c YVl
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: )
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.
i
Xr0 '
�_..tV_..y
Applicant's signature
CAMA Official's si nature �]
Issuing date
----1 ! �,
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203