General Permits (3808)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, . .
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name ,
� + W -� `1 - _�• Phone Number���_�'
Address
City 4 ',,! t, State f . e . - Zip
Project Location County, State Road, Water Body, etc.)
Type and Dimensions of Project _� r i r 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 authorizafiQn_
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�� )
r'
AV
Tl�--- , ,—� — ( �. r�,i� I
Any person who proceeds with a development without the oon- J
sent of a CAMA official under the mistaken assumption that the Applicant's 4v na re
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMA Offic'al (sigrrat�dre
The applicant certifies by signing this exemption that (1) the ap- Issuing datd
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 Expiration dAte S
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203