General Permits (3978)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT f`ED
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as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Re�t}wep-49 r too n
a ea of environmental concern ursuant to 15 NCAC Subcha ter 7K 0203
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Type and 41mens ns of Project 4 � /0 r, /� l / 16 y 1 � ds u
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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.
SKETCH r ;x .;� %a., "'i
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.
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.
(SCALE:
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Applicant's signature d
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203