General Permits (5153)

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 pursuantto 15 NCAC-Subchrapter 7K,y0203.
Applicant Name Phone Number
Address 7.3.E jo,��,.
City State zip
Project Location (County, State Road,, Water Body, etc.)
Type and Dimensions of Project r s£ : �` f ,Y Ile.
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for90,d'ay8 from the date of issuance. Following expiration,
quirement pursuant to,15-NCAC'7K .0203. This exemption to a re-examination of the 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.
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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 ppiicant's signature
development is exempted, will be in violation of the CAMA if there /
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- Issuing date
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 Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203