General Permits (5232)

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CERTIFICATION OF EXEMPTIOI`�I� DEC 0 e
FROM REQUIRING A CAMA PERMIT _
as authorized by the State of North Carolina, lmw
Department of Environment, Health, and Natural Resources and the Coastal ResoulAM�I�SitlM�u«+''
in an area of environmental concern pursuant to 15 NCAC-Subchapter 7K .0203.
Applicant Name <_ i Phone Number
Address
City —ors State Zip '
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project Ko c
Kn h
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant -to 45-NCA6.71K.-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:
R
r(, C ,, Al I/
&nv narcnn whn nrnroaric with n rinvalnnmont withni it tho rnn-
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 signature
��e
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203