General Permits (5421)

-Y CERTIF-I;CATION- OF EXEMPTION �p
FROM REQUIRING A CAMA PERMITV<
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 -to 15.N.CAC-Subchapter 7K .0203.
Applicant Namer�ric�
Address
City l�iaaf iry
Project Location (County, State Road, Water Body, etc.)
State
Phone Number , Ju-Jf
Zips
_.t 14
Type and Dimensions of Project -•, Y� �'
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 .02Q& This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
EC-ef
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: •i,', :., _ ) I
i
Z .
Af I /�Z/ivj,
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: --
�r-J
,./e
Applicant's'signature
CAMA Official's signature
ng date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203