General Permits (4055)

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CERTIFICATION OF EXEMPTION 7'r%
FROM REQUIRING A CAMA PERMIT 9
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to t5--NCAC-Subchapter-7K .0203.
Applicant Name e t Phone Number ►i `i-y"S-
Address >> m11�,a���t�1� cc. • \.)GC
City ' '. , State Ni�_ Zip
Project Location (County, State Road, Water Body, etc.) 1
Type and Dimensions of Project r ,1a,iY\cA
,
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-VCAC 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 9Td4-ys from the date of issuance. Following expiration,
a re-examination of the project and project site maybe necessary
to continue this certification.
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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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment:,)-6 North -Carolina-Administrat+We-Code, K .0203