General Permits (5360)

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Applicant Name _
Address '2
City 2 Pm I
Project Location
CERTIFICATION OF EXEMPTIOr
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coas
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination 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 other State, Federal, or Local authorization.
I SKETCH (SCALE: t r;? 0 ) I
)NP,5 Lh�uik_'
DI mpNs!
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Any person who proceeds with a development without the con-
sent of a CAMA official under tLMA�R
urp}'ttidrrs first fPfa,
development is exempted, will be CA{vIA rf there'
is a subsequent determination t irequired for the
development. 1997
The applicant certifies by signin -
plicant has read and will abide
tion, and (2) a written: Ilt'+e1l�tlfll�A��d�
landowners certifying that they have no objections to the
proposed work.
F,�C►STl N� � e r
/ 1 t� I' Ifi t t
iplicnt's sign
'
s signs re
-� iq
Issuing date I'
)q -7
17h�n
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203