General Permits (3913)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT ri �. n _ C rc'f
as authorized by the State of North Carolina, f
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 p 1 A 1 + 1,.r
Address 9 a !"'/, -s.n ..J iy'.s
City Kr-i,,C 1r.+-P-
Project Location (County, State Road, Water Body, etc.) ` r
ype and Dimensions of Project !'f f
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.
J ['% or r it i
Phone Number
,ttStateY. i" Zip
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.
I SKETCH f g„.." , (SCALE: A ) I
Any person who proceeds with a development without the con-
sent of a CAMA official Sunder 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.
i
190,
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Applicants sig re
CAMA Official's signature
Issuing date
Expiration date
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Attachment: 15 North Carolina Administrative Code 7K .0203