General Permits (4404)

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CERTIE-16-AT�4�0U0:17 EXEMPTION re
_Y FROM REQUIRING A CAMA PERMIT
Applicant Name _
Address 2�
City
Project Location
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.
State Road, Water Body, etc.)
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-15-NCAG..;7Ke�.0203- This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
State
Phone Number ;11 C_
Zip
This ccrtifidafion o?exemption from requiring a CAMA permit is
valid for 96days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
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"tivork.
9-7/-
Issuing date
Expiration date
1
Attachment: 15 North Carolina Administrative Code 7K .0203