General Permits (4337)

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-Y GE tF -==� -= F EXEMPTION , IPA Al'
FROM REQUIRING A CAMA PERMIT
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-pursu..-ot-to-i�5-NaACSubDMpter 7K .0203.
Applicant Name
Address
City v;
Project Location
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement {pursu."Ito 15 NGAG�.7K_0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
9/O-
This cc ifin of exemption from requiring a CAMA permit is
valid fo ys from the date of issuance. Following expiration,
a re-exbfr� netiorTld 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)awritte+n_statement:has-b mobtairiedfrorrt~adjjacent
landowners- certi!ying._.th.at. -they --have noobjedtioris t6­the
p.ropes,ed-wark.
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Applicant's signIatureL
CAMA Official's sigrt ture
9 P_
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

CERTIFICATION OF EXEMPTION
FROM REQUIRING A LAMA PERMIT cam
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 C/ /'tu-1- C/ h Phone Number
Address i -/ ! ,>P r /Q V 7
City /47C1.7.�1_oj1f State ' C Zip s
Project Loc tion (County, Sta a Poad, Vater Body, etc.)
pe and Dimensions of Project
,,J r_^ I -
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.
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.
-ant's siac
CAMA Official's signature
Issuing date
Expirafion date
Attachment: 15 North Carolina Administrative Code 7K .0203