General Permits (3796)

OF EXEMPTION
A PERMIT C
at
ural Resources and the Coastal Resources Commission
frt-tt-VrNC-A0°Subehapter 7K-A263.
Phone Number 9/6- 32? -C /KI
C E RT 1 F1 AT=1 OWN=
_Y FROM REQUIRING A CAM
as authorized by the State of North Carolina
Department of Environment, Health, and N
in an area of environmental concern pursda
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.) _
The proposed project to be located and constructed as described This certi€isation-af-exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for SO days from the date of issuance. Following expiration,
quirement pursuant -to 15 NOAt; K'-:M0'3. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE: y,_ ) I
sX .
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.
Applicant's signature
CAMA Official's signature
12- v Cc
Issuing date
12- 31- 9
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203