General Permits (6367)

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,15 N.CAC.Subchapter7K .U203.
Applicant Name Phone Number
Address
City State Zip ,Y""
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed project to be located and constructed as described
This c^rtification of exemption from requiring -a CAMA-permit-is
above is hereby certified as exempt from the CAMA permit re-
valid for 90 days -from thedate of issuance. Following. expiration,
quirement pursuant to­15-'NCAC 7K .0203. This exemption to
are -examination of th`6 project and project site nray-be necesse+y
CAMA permit requirements does not alleviate the necessity of
to continue -this certification.
your obtaining any other State, Federal, or Local authorization.
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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 f rom-adjacent
landowners _certifying that they have no objections to- the
proposed work.
Applicant's signature .- ,
J1i
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North -Carolina Administrative Code-7K .0203