General Permits (3829)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT' �' C
as authorized by the State of North Carolina, p
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 11hr, 0 Ay
Address
City r. Q
Project Location (County, Sta Road, Water Body, etc.)
1, i
Type and Dimensign of Project 1 0
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The proposed project to be located 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.
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Phone Number'
State /L' '
a 4 n
zip 'd 1sr 6 O
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.
App cant's Ognature
CAMA Official's signature+
Issuing date
Expiration date
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Attachment: 15 North Carolina Administrative Code 7K .0203