General Permits (4985)

C EXEMPTION
FROM REQUIRING G A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmerit, Health, and Natural Resources'and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapte(7K .0203.,
Applicant Name . J(.;, "lr f o,,�' ` '� �- r - Phone Number
Address r>�
City v, .. & e,, .. State a1L Zip
Project Location (County, State Road Water Body, etc.) /n�• • � emu.
Type and Dimensions of Project u /So'
The proposed projectto b located and constructed asdescribed :As certifica' of exemption from requiring a CAMA permit is
S
above is he eby,certified,k s _ em pt,ft4� m the CA fA ermit re z valid forays fromthe date of issuance.. F,ollnwing expiration,
a K`F fi. •,_ :1 'I r*7 «e ,. .
quirement �• This "exemption to:. ire -examination o�t`he project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, "or Local authorization.
SKETCH (SCALE:�,J )
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. r
The applicant certifies by signing this exemption that (1)5the ap- .
plicant has read and will abide by the conditions of this exemp-
tion, and(2}a:writterrstatement-has-be-enebtained4rortf-adjacent
—landowners"-,certifying._that,3hey_have—no":objections—tcr the
—proposed work.
r
®1
Applicant'i'signaturb ! v
CAMA Off iciall''s signature 4
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203