General Permits (5175)

CERTIFICATION OF EXEMPTIOIR
FROMREQUIRING A CAMA PERMIT A997 li
as authorized by the State of North Carolina, ;:�
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Department of Environment, Health, and Natural Resources and the Coastal Resou
in an area of environmental concern pursuant to 15- 1077AGSubchapter 7fC :0203. r�r• .
Applicant Name CA '" i k-v-- Phone Number
Address
City State 3 ,b Zip
Project Location (County, State Road, Water Body, etc.)
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Type and Dimensions of Project `a's�> r�> %�;x,' 4 . - , ' _ - i , >' X
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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.
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: )
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44 _
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.
Applicant's sigo�ure
CAMA Official's signature
Issuing date
Expiration date
Attachment:-15-North Carolina Administrative Code 7K .0203