General Permits (4252)

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Applicant N
Address,
City LL. j
Project Loc
CERTIFICATION OF EX�
FROM REQUIRING A CAMA PERMIT �1l;
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Corrjssion
in an area of environmental concern pursuant to 15 NCAC Subcl;iWO 7K :0?0A,,,
Phone Numbe
I ype ana uimensions of iuroject
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.
1 r
77
SKETCH { i t dr t` ` i L.
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.
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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.
ApplicarA's signaturg /1
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Issuing date
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Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203