General Permits (6204)

i 1
CERTIFICATION OF EXEMPTION % L
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
i in an area of environmental concern pursuant to 1.5-NGAG-Subchapter--71K,020a N 6S ; %s ir .S, S
Applicant Name Phone Number
r Address
City State Zip " .;-2-0
Project Location (County, State Road, Water Body, etc.) 77rfL
C
Type and Dimensions of Project r- -
i
Nc'it -
li The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for90 days from the date of issuance. Following expiration,
quirement pursuant to 15-•NGA07714 .0203— This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
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 Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the =• �sf �--���
development. CAMA Official's signature.'`
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•wr4tten statement -has beenobtained from adjacent
landowners -certifying--that they have- no objections 4o the. Expiratiori date
proposed work.- -
-
Attachment, 15 North Carolina Administrative Code-7K .0203