General Permits (5573)

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CERTIFICATION OF EXEMPTION
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_Y FROM REQUIRING A CAMA PERMIT 1�/Oel �'Gr ¢n d j
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 CJ eT ��'~
Address � fir" � to
City t� 3 F a i
Project Location, (County, St to Road;, Water Body, etc.) f
to , 1, P"
F
State
Type and Dimensions of Project �lr,, r .r t ; . ! 1,4, °n
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 ' " ;, " of_ ; ",'5'
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.
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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 from adjacent
landowners certifying that they have no objections to the
proposed work.
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Appncant-s signature ,
CAMA Official's signature %
lei!, �) ,?` 9�
Issuii-n7g date
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Expiration date '
Attachment: 15 North Carolina Administrative Code 7K .0203
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