General Permits (4253)

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CERTIFICAT[ON OF EXEMPTION 9 ?�
FROM REQUIRING A CAMA PERMIT �Jl
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•pursuantto-16-NCAC'Subeitapter•7K-.0203.
Applicant Name Phone Number 4'S2 .7
Address"
City State zip ,74 S"w
Project Location (County, State Road, Water Body, etc.) r
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to"1'5"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.
I SKETCH (SCALE: ) I
4e' re
4 - 21
7491 el
1
I j
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) awrittenstatementlias beenobtarr%d'frorn adjacent
landowners --certifying that they have no objection - ta-,the
proposed work.
Applicant's signature'.
21
CAMA Official's signature
Issuing date
Expiration date «>+iiir.w�■r,,,■i.■�„
Attachment: 15 North Carolina Administrative Code 7K .0203