General Permits (5920)

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CERTIFICAT1.0N- OF EXEMPTION
FROM REQUIRING A CAMA PERMIT r'd
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 pro�§itantto l�S NCAC-Subehep'ter .-K-0203.
Applicant Name 1i�� ! s Phone Number 7-2 e - .. , %S
Address '__C, �'6,
City ,?
Project Location (County, S
, Water Body, etc.)
et.,1,
Type and Dimensions of Project ,
On
Th
e proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pufsuantta 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.
State S G Zips
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.
SKETCH (SCALE: i,)
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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 beemobta'tned from adjacent
landowners certifying that they havenoobjections -to -the
proposed work.
Applicant's signature (,
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203