General Permits (6916)

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CERTIFICATION OF EXEMPTION�E
_Y FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, OCT �` 2 Department of Environment, Health, and Natural Resources and the Coastal Resources Commiseigp
in an area of environmental concern pursuant to 15 NCAC Subchapter-7K .0203.
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Applicant Name �� <; �c. - i Phone Number
Address aus�
City State iL zip
Project Location (County, State Road, Water Body, etc.) n.,i„ N r,c/ uIILv , ��v tj1 ? f�✓.,iy. i
Type and Dimensions of Project
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.
This cc-tification 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.
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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)awritten statement has been obtained-frbYn-adjacent
IandQwners certifyjng., that they- have- no objections--to--the
proposed work: -
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Applicant's signatu
CAMA Official's sianature___
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203