General Permits (6875)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMITEB 0 2 Z000
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 NGAG-Subchapter=-71K- 0461,
Applicant NamePhone Number,��;'
Address .6,2 Y
City > . • t # State C. Zip
Project Location (County, State Road Water Body, etc.) ay. X- .. - .r g
Type and Dimensions of Project t n t
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 N9Af5-7K-a7203. 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: )
4V.
G• r ° 4,�j �
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.
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Applicant's signature C
AM iciaV6 signature
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Issuing date
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Expiration date ff i
Attach ment:_ 1.5_Nprth, Caroli tea Administrative-Code~3K-0203-