General Permits (7067)

CERTIFICATION O EXEMPTION
_Y FROM REQUIRING A CAMA P RMIT
. l
as authorized by the State of North Carolina,
Department of Environment, Health, and Natesources and the Coastal Resources Commission
in an area of environmental concern pursuant t51VCA-i,-�-3vbchapter"7K- G2t13.
Applicant Name ` a, �:` i .f - Phone Number f -'C.''
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-N�AC-7K 0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
•i.•'4CsS � J �L. � <S� �'•J �'J
State -i
Zip
7
This certjfication of exemption from requiring a CAMA permit is
valid for10 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 0 rw (SCALE:
i
1,411(
A) i
I
�� t
I
I
i 7
t
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 (2j`aWriften ssnre-fm hastue'rtzM a►n-ed"fr"crm-9d)'ac-dnt
-landowners-ceftifying-•th'aMMil y- -fiave no o-5jectiorfis"'to-ttte-
-proposed-work-­
Applicant's signature
CAMA Official's signgture
Y 1
Issuing date
Expiration date
d
Attaciir5i�nt:-1�-flQrttrGarotirt'a"Adm€€ii7st>r2rti�"Cade 7ff-0203�