General Permits (5822)

CERTIFICATION OF EXEMPTI
_Y FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, (�
Department of Environment, Health, and Natural Resources and the Coastal f.L+r�ae.Cai�i��•e.�.ra.
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name. I i Phone Number
Address'-��-
City State fJ Zip
Project Location (County, State Road, Water Body, etc.) _'Z) < r�✓._tL
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuantto"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.
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.
Applicant's sign4ure
CAMOfficial's signature
(/
Iss ng days
Ezpiratign date
Attachment: 15,North Carolina Administrative-Code-7K• ,G203