General Permits (5356)

O
CERTIFICATION OF EXEMPTI
FROM REQUIRING A CAMA PERMIT PR 1 4 ,997
as authorized by the State of North Carolina, 4
Department of Environment, Health, and Natural Resources and the Coastal R
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203molowrs,01060MA11641y-
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Applicant Name Phone Number
Address
City State Zip
Project Location (County, State Rbad, Water Body, etc.) ?
Type and Dimensions of Project
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.
n r Y �'• r t r�i', n C"i ,
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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Any person who proceeds with a development witnout 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,k.A"­4 r d
(IVA!XE'Y!
Applicant's signature
CAMA. Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203