General Permits (6283)

-1r-
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT �J��
as authorized by the State of North Carolina, V
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15-NCAC-SUbdha0fer7K .'0203.
Applicant Name t.._o'c 1_�r,c�%`��'` --� Phone Number Q'S_�
Address
City r State 'N <:i .. Zips.
Project Location (County, State Road, Water Body, etc.) Uri 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 1-5-­N0AC 7`E .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
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: )
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.
Issuing date
Expiration date
Attachmezr=4 tt� rtrolina Administrative-C--ode 7K .0203