General Permits (4361)

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CERTIFICATION OF EXEMPTION
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 pursuant to-15-NOAD-Subchapte�.7K,0203:-
Applicant Name a' iJAi;.1 1`?1/ 6G4J,";,41Phone Number ;, )
Addressl'v
City ? , : , I ,., State ,,�,! . Zip f I
Project Location (County, State Road, Water Body, etc.) 6,r,
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Type and Dimensions of Project:D,
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-NGAG 7K-:02e&.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-gGdays 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 . e c --! � , (SCALE: ) I
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.
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Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachmeat-15 North Carolina Administrative Code 7K .0203-