General Permits (4472)

CERTIFI,C-AT10N- OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, (i�
Department of Environment, Health, and Natural Resources and the Coastal Resources Commissiq�
in an area of environmental concern•pur-suant.to-45-NGAG Subchapter 7K-:0203.
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
r
Phone Number , 's :c S �­-)
State % Zip';'7-Yr'3
Type and Dimensions of Project / 4,;0 4,-, ` 7 _
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement-pursvant'to 15 NCACL'T�0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This cerfification.of exemption from requiring a CAMA permit is
valid for90-days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE:
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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)-awritten-statement'trash`ee"n•obtained4,rom•adjacent
landowners "certifjring"ghat tfi�jT" fTdve- tto obrectior�s• to �tkie
proposed•work:
Applicant's signature z / J
CAMA Official's sigrr`ature
1#_1 f , � 6 !
Issuing date
2- 3 / 7
Expiration date ,...■...■.....•••�■■•■■••
Attachment: 15 North Carolina Administrative Code 7K .0203