General Permits (6928)

CERTIFICATION OF EXEMPTION Nov o 1 zo»
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, DCM-MHD CITY
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter-7K .0203-u I I �A-1us(s�ib)(s
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
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-NCAG-7K-:0203; This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Phone Number 60) W-131d3J 1
State Zip a ��
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.
sent of a LAMA otticial under the mistaKen assumption mat me Applicants signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMA Off icial`s signature
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.frenradjaczint
landowners certifying that they have --no -objections to -the
_proposedwork: - -
Issuing date
Expiration date
Attachment' 15 Nbffh`Carolina-Adrninistratiy-eCode 7K .0203