General Permits (6569)

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Applicant Name i
Address ,00
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT AUG 12 1998
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
nne� of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
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�G�t;S >//► kF-F--t✓ Phone Number y5
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City
Project Loca/tio-h (County, State Road, Water Body, etc.),
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Type and Di ensions of Project - FAX- c.-1 v z r J-1 4 ;
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 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other tate, Federal, or Local authorization-,., ,, x^ Ct'
SKETCH
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.
(SCALE: )
Applicant's signature_
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iCAM,A Official's sign re
Issuing date
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Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203