General Permits (4412)

z:
CERTIFICATIONS OF EXEMPTION /\.k
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,NCAC Subchapter 7K .0203.
Applicant Name Phone Number 1�i ,% �- 6
Address i
City ,off, /,?, State _ ,-tic' zip 20,17 z-
Project Location (County, State Road, Water Body, etc.) r ' - l c C t 4
J
Type and Dimensions of Project r, v
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 71<7-MOS. 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 9&days 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 e ( /
lf
is a subsequent determination that a permit was required for the /u �� �/ C_ a
development. CAMA Official's sigrAture
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 wofk.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203