General Permits (5737)

-�r- CERTI--FICATION 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 pure; antwta-15 NCAC Subchapter 7K .0203.
Applicant Name ' Phone Number
Address _606?
City c+�n,• % State . AJC r_ Zip s
Project Location (County, State Road, Water Body, etc.) !SS t ;f� • !;, �'�+ 1
J'41 c�
Type and Dimensions of Project n!T mar
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant-te-1-5 NGAC-7*-820&-This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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-writtenstatement has been obtained -from adjacent
landowners, -certifying: that they have no objections -_to -.the
proposed. work.-
I
This certification of exemption from requiring a CAMA permit is
valid for-90Aays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
{� 2,d �Cj
CAMA Official's signature
Issuing date
-.3/ -�i?
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203