General Permits (6926)

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CERTIFICATION OF EXEMPTION RECEIVED
_Y FROM REQUIRING A CAMA PERMIT NOV 0 1 2011
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources C47�Ti� '
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K :0203-� I �% ?Tf
Applicant Name Phone Number
Address
City State V I- Zip a t 4
Project Location (County, State Road, Water Body, etc.) , N ( - , ). } ,{ #! 1 C
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Type and Dimensions of Project u f , j -t tL.
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 certification of exemption from requiring a CAMA permit is
vali6-for90 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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'� 13
OL
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 obt-Al-h6dTrom adjacent
landowners certifying thaat they --have -no objections`to the
proposed -work- - .
x
Applicant's signature
CAMA Official's signature
Issuing
Expiration date
Attachment: 15 North Carolina Administrative Code7K .0203--