General Permits (6365)

CERTIFICATION OF EXEMPTION _
FROM REQUIRING A CAMA PERMIT t� �"�l'"��1� �
as authorized by the State of North Carolina, +a `�',
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15-NCAC Subchapter7K .02.03.
Applicant Name Phone Number `+ `-,b'A
Address -)U `4
City State, Zi 3 )
Project Location (Countyq State Road, Water Body, etc.)
Type and Dim=ns 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. 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
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: 4r3N ) I
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n.. .,�,.... .,Al . ,itk n Anxiolnnmont withni it tho nnn-
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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.
v.
\j
Applicant's signature
CAMA Official's signature
Issuing date
J�
Expiration date
Attachment: 1-5-Noyt�TMTI-dm--ft-gt-r-aTTq� Code 71<'°.0203