General Permits (6790)

1CAG,Ci C-7()QV'\'�
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT t AAP 1 820 00 i
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-NCAASubchapter..7.X..�132.Q3. _ -
Applicant Name \-,..)Ur+ Phone Number ' 5� �i ��! • i�ti
Address
City State ay Zip d-)xJl
Project Location (County, State Road, Water Body, etc.) w. ', C� `sR t ;�u ::;, t�� i 't '•_° :' r
Type and Dimensions of Project ;t- � c rc a •. -,� �.• '3 h i c.
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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'=A-C-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:
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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 from adjacent
landowners certifying that they have no objections to the
proposed work.
1
Applicant's signature
CAMA-Official's signature
Issuing date
Expiration date
Attachrmcsht."t'5-R6ft H'Carolina Administrative -Code 7K .0203