General Permits (5426)

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CERTIFICATION 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 -pursuant to 15 NCAC Subchapter-7K :0203.
Applicant Name / $ aoa
Address : "e). x ''
City
Project Location (County, State Road, Water Body, etc.) X z
Type and Dimensions of Project
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuarttto 15--NCAC-7K--M01 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number
State XIC zip .," %}
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Zz­
4, Y
This certification of.exbmption 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.
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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 fromadj'acent
landowners certifying- that they -have`- no objections to -the
proposed work.
Applicant's signature . rj
Lam•. %" �
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203