General Permits (5392)

CERTlFIcA­T--1.-G,N OF EXEMPTION
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 p.ursuant-to4S-4GAC-£iubohapter•--7�K:6;03..
Applicant Name
Address
City lice. j.
Project Location (County, State Road., Water Body,
roi
Phone Number %SAS- % V7
State A / - Zip ?fa' 97
Type and Dimensions of Project
d
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant.to 1�NC-A0 1Kr-@M. 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: /V, ) 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.
Applicant's signature
CAMA Official's signature
Issuing date
7 - ), / - �-1 i
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203