General Permits (4817)

1� CERTIFICATION OF EPAP9TK!I
Y N N �11
FROM REQUIRING A CAMA PERMI VVV
as authorized by the State of North Carolina, —
Department of Natural Resources and Community Development and th6-CoatTir enurms Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
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.
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.
State
Phone Number 7)0 Zg
2
This certification of exemption from requiring a CAMA permit is
valid for4) days from the date of issuance. Following expiration,
a re-exa ination of the project and project site may be necessary
to continue this certification.
Applicant's signature
CAMA Official's signature
f C1+�•.r �Ut�L
Issuing date f
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203