General Permits (6251)

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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•NGAG•Subehapter•7K :02aa
Applicant Name
Address f,3 2"7
City
Project Location (County, State Road, Water Body, etc.)
Phone Number 7,?.�' ' V f
State C zip ")7/
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 NC7AC'7K".0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Ttris-ccrtification ofexemption from requiring a CAMA permit is
valid for 90 daysfrom the date of issuance. Following expiration;
a re -examination -of the project -and project site may be necessary
to continue this -certification:
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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
? /T
Issuing date
Expiration date
Attachment: 15 North -Carolina -Administrative. C.Qde,_7. K .02.03