General Permits (6218)

4
CERTIFICATION OF EXEMPTION
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
in an area of environmental concern pursuant -to 1-5 NCAG Subchapter 7K .0203.
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Phone Number �f ` Cj.. l�
State ��kjf r' 'r, Zip -., r-;
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 pursuant.,.to-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
vaf d for•90 daysfrom the date of issuance. Following expiration,
a•re=examinationof the project and -project site may be necessary
-to continue this certification.
I SKETCH (SCALE: ) I
J1 %f;- '! i
`�✓��'%',� � ..-ftr�' �L•�C:%ri,��.���+r- /.:i��: cl ,L' t �,!>!c s..L
�'r� , i . ,. , . , . :`�t� '(i'tr,r•, •.�� �I. �-7Y'c�♦ !try. y-•l . ��,v%�(a , �; �• «��
r''<� < ��� •' �..�,✓s • .��- ...� �:. � fir,' /�r � , s s.� �fS �- - � S• r¢— `.r6i
7ir . �v l _ ��9' �'�`%�" /%�i.at.ryrG� 7� G-` � r' �L,�s�� ,C • /`�!7'� / �LI"i',�
�7, .f jz'��`� y r � a ��'� J.J ..�'� .. � /" [ L�1 [f .6 r 1••£%/ I'T'r/'� -F . .
.. •;.-'%' ,�;,(;�.. s?v l._ tom+ r,�� , ; /� rr.St ,p� �c: i t /! � �,r`r'�'' _
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: 1,5 North Carolina Administrative Code 7K .0203