General Permits (5768)

CERTIFICATION 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 Resource:
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
TIN RL,
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Applicant Name [ `eV *�r _ j �'- r- f"q Phone Number .4 4 to - "u— 9 ca t
Address 1-,�- cl O e , .h; `u•'iud
City , -+ r.-, ,, ol -r 0 State ia�) zip g �tj �4 J
Project
jLocation (County, StatlRoad, Wat4 Body,� etc.) rwde,- - {. Uk t 3,)m -, � ,r ., d
(j
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Type and Dimensions of Project RCAI) ix, n cur, , 4
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.
SKETCH
�i
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.
(SCALE: )
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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.
1001
Applicant's signature �--�
CAMA 9fficial's signature
Issuing ae��
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203