General Permits (5494)

Applicant Name
Address
City
Project Locgtior
CERTIFICATION OF EXEMPTION��-
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, J U L Q 81997
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission U
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.0
i ,tAC je_. + .ti,� 61p" t ,[.1r.-0( rI('-I' Phone Numbe -_ C }(
;:ti 'Y!r : ; nr,V%C"►^, State
(Coupty, Statp Road, Water Body, etc.)
Fi ro s(J: +__' ceAr\
Type and Dimensions of Proj
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.
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.
I SKETCH (SCALE: rJpT %t) ) I
4
of f
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.
s
CAMA,'Officiat's sign
issuing date i
Expiration date
1119-3
Attachment: 15 North Carolina Administrative Code 7K .0203