General Permits (4938)

CERTIFICATION OF EXEMPTION
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#C�AC 5�bel�aptewwzFk-9293: ♦ _
Applicant Name t ,rv. r
Address
City
Project Location (County, State Road, Water Body, etc.)
R( R. Ir
State
Phone Number L2 M.>fiAl
Zip a-"-1 v
Type and Dimensions of Project A l ; � of ' r •.-+ ; ::, . tr. ,. A ._ 1-1-
!'c am!,.(.
The proposed project to be located an 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.
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: NT,_ )
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Any person who proceeds with a development wnnout 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..
v
Applicant's signature
CAM,t Official' signature
Issuing date
1
':) lc -
Expiration date
Attachment: 15 North.Carolina Administrative Code 7K .0203