General Permits (5827)

CERTIFICATION OF EXEMPTIO ,
-Y F� , 4) 0 A907
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resouurcest � T�t1R�SltiRi►'
in an area of environmental concern pursuant to' F.N43AC-Subchapter 7K -0203._ _..
Applicant N
Address
City
Project Loc
h1 �1 Y�ty�
(County, State Road, Water Body, etc.)
CG.r.,o.! CR� �: 0 )INc,rCA
State
Phone Number I -% - citA
Type and Dimensions of Project C c
d
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'S:NGAC-7K` G203, This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
zip ai rA \J
co--" r'-.
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.
I SKETCH (SCALE: NUN',_: ) I
7)
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.
CAMA Official's signature Q
\Y� -bq�ti�
Issuing date
Expiration date
Attachment 15 North Carolina Administrative -code 7K-:02-03.. __