General Permits (5821)

Applicant Name _
Address
City
Project, Location((
CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Res
in an area of environmental concern pursuant to 1,5-N0A-0-&ubchapte7-7K .-0203.
unty, State Road, Water Body, etc.)
State
1 0.1997
Phone Number` i\g • 5-1613
Type and Dimensions of Project ``-% z,c , -- a t�\' \ t:), 0\
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1-5_.NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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.
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.
Applicant's signature
\L
CAMA Official's signature
y�\ 06W.\,k \SS D
Issuing date
�i —1UN' 0 N�C�
Expiration date
Attathmant_-t5 North Carotina'AdministTatfve Code 7K .0203