General Permits (5234)

RTI_FICATION OF EXEMPTION
FROM REQUIRING A CAMA-PERMIT
as authorized by the State of North Carolina, r
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
n an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
.Address r �` �� �� Ci� a C�
ty ..."' State 3„ZI
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The proposed project to be located and constructed as described This cc-tificatioo of eymption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 96'dayiMom the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re -exam ina io 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-othdrSra—eel=etTetal s1�ocalauthorization.
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Hny person wno 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
t�.
Appli nys si n ture
CAMA Offirjal's s,(gnatu* q/
Issuing data _ f �. 7
Expiration date,/
Attachment: 15 North Carolina Administrative Code 7K .0203