General Permits (6892)

F �JJ
CERTIFICATION OF EXEMPTION DECEIVED
FROM REQUIRING A CAMA PERMIT OCT 2 5 201
as authorized by the State of North Carolina, 1
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0207/ p3:1_1CM-MHDCITV
Applicant Name,�i', tl� ? t_;; i� - r �_s� Phone Number
Address
City State ?J i Zip
Project Location (County, State Road, Water Body, etc.) ! rYC if` 67te'l i k' A=-
Type and Dimensions of Project it i � r A-( L�� << /i\ ;r: it 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 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 writtan-statement. has.be.en.obtained-from adjacent
landowners certifyirag_..that-they have no --objections 10 "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.
Appucanrs signawre
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 71K.0208,