General Permits (5620)

CERTIF1CATI0N-OF EXEMPTION
FROM REQUIRING A CAMA PERMIT C
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•1shfCAG'Subehapter?K .fl2&3.
Applicant Name Phone Number
Address
City - : r r r State /SIC Zip Ftitt
Project Location (County, State Road Water Body, etc.)+� ' -�- e:`rr• r/ = f�cr- �i ,
! ype ana u!mens}ons of rrofect riw t,,,, , // ,",7 . .-x, ;.�^sr ,U .• t., �,., « n.c. Nvc+Y`
The proposed project to be located and constructed as described This certi#icationi5f"exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for'9© days from the date of issuance. Following expiration,
quirement pursuant to 15'NCAC 71<--.'0203This"exemption to a re-examination-ofthe project and project site may be necessary"
CAMA permit requirements does not alleviate the necessity of z to continue this certification.
your obtaining any other State, Federal, or Local authorization.
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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'statem'ent has-been obtained from adjacent
landowners certifying -'that-they have- no objections- to --the
proposed -work.
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Applicant's signature -
CAMA Official's signature
.�Cc D i IN7 !i:
Issuing date i
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203