General Permits (4974)

9
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT f,(
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. 1 j
Applicant Name F-,I C {.AAil3 fah; AL-,
Address
City State
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.;NG'A0 7K .a203 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Feder 1, or Local authorization.
�'.
Phone Number 11 - —f t y
Zip
This certification of exemption from requiring a CAMA permit is
valid forgo days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: ) I
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GEC,: -A �J
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signature ;
development is exempted, will be in violation of the CAMA if there r �`
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
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 - tFre-
proposed work.
Issuing date
Expiration date
Attachment: 15 North Carolina.Administrative.Code 7K,0203