General Permits (5455)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT por
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
Address
Citv
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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 .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number
State
Zip
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.
Any person who proceeas wim a oeveiopmem wiuiout uie wir
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted, will be in violation of the CAMA if therei--�==- L---
is a subsequent determination that a permit was required for the CAMA Official's -signature
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.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

CERTIFICATION OF EXEMPTION -
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, on I l
Department of Environment, Aealth, and Natural Resources and the Coastal Resources o fission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Nam ��� >i r c. . `a �r�i Lir. fc � Phone Number 1��i (D --
Address Doi 1
City State � S _ Zip
Project Location (County, State Road, Water Body, etc.) _ r` iCl�Yr
Type and Dimensions of Project "'2; "�S r�-� - sc "+'
The proposed project to be located and constructed as described This certification of exemption from requirin ��A p it is�
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the dat issuan� �gwing ratio
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the proje an r le sit'a may ne es
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, gr ocal authorization.
LY
SKETCH (SCALE: )
j
{ iirr I
yi
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r
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the /Applicant's sigr�yature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMA Off icial'ssignatule
1_lf�l9`�
The applicant certifies by signing this exemption that (1) the ap- Issuing date Alplicant 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 Expiration date /
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203