General Permits (6981)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in flfian area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name `". Phone Number
Address , _
City t ' State +�1
Project Location (County, Stale Road, Water Body, etc.) .
Type and Dimensions of Orojecf _ .1-1-1-1-1—.11-1-1—
The proposed project to be located and constructed as LI
above is hereby certified as exempt from the CAMA quirement pursuant to 15 NCAC 7K .0203. This exeCAMA permit requirements does not alleviate the ne
your obtaining any other State, Federal, or Local authorization.
This certifkati n of exemption from requiring a CAMA permit is
�
da+�s from the date of issuance. Following expiration,
i atn of the project and project site may be necessary
tuturiLlnuo-M.- certification.
SKETCH (SCALE: ' z Z, U I )
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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.
Applicant's sipai�ture
CAMA Official's signature���—
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203