General Permits (5369)

Appl'r'cant Name _
Address
City
CERTIFICATION OF EXEMP Qa 7 19
FROM REQUIRI_CAMA PERMIT }
as authorized by the State-q�q�� rth Carolina,kgM�t•rgqqgpkp+„p
Department of Environmen#?44e�lth, and Natural Resources and the Coastal Resources Commission
in an area of environmenta c ern pursuant to 15 NCAC Subchapter 7K .0203.
"Xr l Phone Number 6n)
Project Location (County, State
,, -- -
Type and Dimensions of Project
, etc.)
The proposed project to be located and constructecl4-described
above is hereby certified as exempt from the CAMA�r� it re-
quirement pursuant to 15 NCAC 7K .0203. This ex Lti�to
CAMA permit requirements does not alleviate the neof
your obtaining any other State, Federal, or Local audio;
State er'e; Zip =?
This ccrtification 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 (• r f - (SCALE:
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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.
Applicant's signature
CAMA Officia's signature-
/
2/'��6
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203