General Permits (4027)

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CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT
J U L O 81997
as authorized by the State of North Carolina,��
Department of Environment, Health, and Natural Resources and the Coastal Reso LQ
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.s "— -- �)
Applicant Name ff Phone Number]
Address
City F 1� r-t State Zip
Proje t! Location (Cpunt , State Road, Water Bppody, etcy.,� ) � E-r- � ` u M I. y-,• ', �'r • P.r 0i
I'Ay
Type and Dimensions of Project o oc (eel)�ic� �m'� {fir"' -��� c r� (rw) +1
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.
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:
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go-
f�1 r ✓ L-01
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signat e
development is exempted, will be in violation of the CAMA if there ,
is a subsequent determination that a permit was required for the
development. CAMA Off'" ial's sig nature
The applicant certifies by signing this exemption that (1) the ap- Issuing date J
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent 311 99 I
landowners certifying that they have no objections to the Expiration date !�
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203