General Permits (3831)

O
CERTIFICATION OF EX
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, Im Department of Environment, Health, and Natural Resources ' " I c mission
in an area of environmental concern pursuant to 15 NCAC Silt�CflftrTIF-6P®8!�"�••r�r,
Applicant Name Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
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.
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.
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.
nature
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203