General Permits (7310)

CERTIFICATION
-Y
FROM REQUIRING A CA
as authorized by the State of North Carolin
Department of Environment, Health, and N
in an area of environmental concern pursu
Applicant Name \r
Address '� 3,'y'�
City.
,,{fP��roject`Location (County, State Road, Water Body, etc.) ��
OF EXEMPTION �
MA PERMIT
a,
atural Resources and the Coastal Resources Commission
ant to 15 NCAC Subchapter 7K .0203.
Phone Number ,
State Zip A
Type and Dimensions of: Project _�:�; �. 'r. ` G ; �4 ;�.
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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.
SKETCH �� i .'�: i' -\,, Q...,j
This certification of exemption from requiring a CAMA permit is
valid *,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. s
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Any person who proceeds with a development without the con- I
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 signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203