General Permits (6717)

-Y
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 NCAC Subchaoter 7K .0203.
Applicant Name Phone Number -t
Address D n
City State Zip
Project Location (Cou ty, Sta Road, Water Bod , etc.l 40,�,
/— !c /
f7/�% f l4nl S f t �Ar tn� �- lip 0
Type and Dimensions of Project
The proposed project to oe iocatea ana constructea as describea
aoove is hereby certifies as exemot from the CAMA oermrt re-
cuirement oursuant to 15 NCAC 7K .0203. This exemption *o
CAMA permit requirements does not aileviate the necessrtv CT
.;our obtaining any other State. Fecerai. or Local autrtcnzanCr..
This cer,ificauon ct exemption 'rem requir:rg a CAMA :.e-_ ! s
valid `cr 40 oays 'rcm the date cf :ssuance. Fotlnwirg exc r;• c_
a re-examinauor ct're orolect arc oroiec: sae nav oe ^ecessar•.'
to continue this cerimcation.
SKETCH' �� -- KCAL:. Jv �
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Any person who proceeds with a ceveicoment 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.
I
CAMR-Off icial's's'ignature
S9 D
Issuing date
E -pirafion date
Attachment: 15 North Carolina Administrative Code 7K .C203