General Permits (6021)

-� CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT `' `
as authorized by the State of North Carolina, MAY d ). 1999 -
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15-NCAC Subchapter-7-K .0203.
Applicant Name 1 cr ..,� �� . .0 r"z��> Phone Number 2'3s - -1 S-(, • h)5" a
Address
City State tv.._ Zip1Kti
Project Location (County, State Road, Water Body, etc.)
Type and and Dimensions of Project 7,,rc,_ C � I _ti,�, r \
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1b NCAC 7K .020&. 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.
SKETCH
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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 signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15-North-Carofina Administrative Codg--7 020.3