General Permits (5341)

O
CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,`= �+
Department of Environment, Health, and Natural Resources and the Coastal Reso 06,,
in an area of environmental concern pursuant to 15"NCACSubohapter7K M03.
Applicant Name Phone Number �4S k!)
Address �__) ®3
City s s :,�, . , r•.
Project Location (County, State
A 1,
td, Water Body, etc.) _
Stat
Type and Dimensions of Project k''
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=7W.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.
I SKETCH (SCALE: :. ) I
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.
l i I
Applicant`s signature
CAMA Official's signature
Issuing date
Expiration date
Attachment:15 North -Carolina Administrative Co&—.7-K•:0203 .