General Permits (4126)

CERTIFICATION O-F EXEMPTION
0
FROM REQUIRING A CAMA PERMIT �1,0A
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 1.5 NGAG-Subehapter 7K .0203.
Applicant NamePhone Number 2`f �'r�7
Address `e�!2 e / A �.
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project e
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-- U203. 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 forr90-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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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.
i
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Applicant's signature
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CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203