General Permits (3904)

��, ti, "
-Y
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT -7
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission f
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name e Phone Number
Address A",
City --t t o State zip 9 S I
Project Location (County, State Road, Water Body, etc.) , C --7,a � .0.1 e' �� -� l / �' �J �a r
< 1-0�f Z 1. I A;��-) /� -7a/C. A0I-
ype and Dimensions of Project (I_o4liff -o !g i,i
ce x i
The proposed project to be located an?Jrll onstructed 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.
, Z v ,4t
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 ,_ Y (SCALE: )
0 i
G e
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.
s
CAMA Official's signature 10/
Issuing date
.� -- 31-
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203