General Permits (4610)

CERTIFICATION OF EXEMPTION �-
-�
FROM REQUIRING A CAMA PERMIT �
as authorized by the State of North Carolina, 1- 1aen
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 ` -f ;^ Phone Number
Address
�..
City - --� State Zip
Project Location (County, State Ro d, Water Body , etc.) 1 1
f7 � • � ,I r`f, cA A P C U ^ u 1 t'S I' J .-. S 4v r
Type and Dimensions of Proje t Kcluc! too f r b-
c i 5k, r-'t' . a,V r,
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.
l�h (e it L` [1 .n -- / 'I - K 4 1 f e ! r
w// 4r,, P
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.
SKETCH (SCALE: I,!
t,
f
n .. .d, , .. --A. with n -Invoinnmont without thA 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.
i---=�*--
Applicant's signature '
CAMA Official's signature
Issuing date
LJ
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203