General Permits (5390)

CEEXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant..to4a&&NOAG-Subohapter-7F<.,B2-off.
Applicant Name __
Address
City��
Project Location (County,
Type and Dimensions of Project
Road, Water Body, etc.) _
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
,-k C .
-
Phone Number 726.3ud,P
State ,fic zip 2 ks r7
This certific on of exemption from requiring a CAMA permit is
valid for s from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
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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) awritte-t-statement. has been -obtained froft adjacent
landowners certifying that they have no objections to the
proposed work.
CAMA Official's signore
Issuing date
2 ci 9
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203