General Permits (4654)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, A�A s nnvv ���
Department of Environment, Health, and Natural Resources and the Coastal sion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name j "' r`"t' c, �/ ` %' Phone Number
Address
City !' State
Zip'.
Project Location (County, State Road, Water -Body, etc.) , '5' C- !' ' •� 5 > `� r:,:
f . K y � t ( r:,i i i +! ; t 1 C n i4 ! _t , 1.., . � V" r' ,1
Type and Dimensions of Project V lug V f ,a
1
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.
,#-1 V .A �J MCA, t ( tt l
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:A/b )
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) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
Applicant's signature
CAMA `Off icia1"s signature
Issuing date /qq I
Expiration date` .; - I
Attachment: 15 North Carolina Administrative Code 7K .0203