General Permits (4312)

CERTIFICATION OF EXEMPTION
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 15 NCAC Subchapter 7K .0203.
Applicant Name iti(_{ \may /r'r �l,S Phone Number
Address
City
Project Location (County,
Type and Dimensions of Project
Road, Water Body, etc.)
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.
sent of a CAMA official under t E#lgpb opd t
development is exempted, will b m8ft AMA
is a subsequent determination t a permit was re uired
development. MAR 191997
The applicant certifies by signir�]jF� io
plicant has read and will abide ""'"�� con itions oft is exec
nw��0ne�s qww"A ►
tion, and (2) a written statement has been obtainec�l'�rom adjacent
landowners certifying that they have no objections to the
proposed work.
State
Zip
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.
Applicant's signature
a
C -sr-17
CAMA Official's signatur
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203