General Permits (6523)

Eddtj M%jers 919-720-5005 P.1
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by th® State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of ertvironm Mal concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant NamePhone Number Jl
Address _
Gity : axe L4w Zip`
Project Location (Courtly, State Road, Water Body, etc.}
Type and Dimensions of PrpleCt _ —`— 3 cam.
The proposed project to be located and constructed as desvnbed
above is hereby certified as exempt from the LAMA 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.
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.
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,
s signature
CAMA
Attachment, 15 North Carolina Administrative Code 7K .0203

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Location: c-S `�, . �, /�Field Rep. 7VP
Phone: Date cf P.Eport: S
Description of Project: -cam(_ �, ��� �(b�v�� (✓ ��
Date Project Reportedly Comp-ltte :/a L
(1) Do the measured dimensions of the developmen 'iffer from those
indicated in the pE=it .and plat?. Yes ho Fave all pernit
conditions peen satisfied? Y / No
COMMENT:
�EQ1tTiEntatiOti a?nC Fresion Ccntrol: Has peI-1iL. sc=r.E
or C Zner- ise ZE^_ all G1stllrAEG arc? �r / 1 G
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(3) Future Neniterinc and Znfcrcement P_ck
or enforcement action needed? Yes
COUNT:
Cras sc��
. I=_ furu:er i nves titration