General Permits (4531)

CERTIFICATION OF EXEMPTIO ' JUL 2 5 1997 �±
�.
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
Address (Tr
City v�
Project Location
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 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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i
Phone Numb e I i f i _-V
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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SKETCH (SCALE: i )
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wo
M„ .. ahn nr^nnnfic with n rinvoinnmcnt without tho mn-/-
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.
CAMA Official' signature Q
i f
Issuina date 11 11
It) / (&
Expiration dat6
Attachment: 15 North Carolina Administrative Code 7K .0203