General Permits (7458)

O
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 an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
'A�
State
Phone Number
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
I SKETCH (SCALE: ) I
1?L
j
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 obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
n �tti'`:.
A
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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CERTIFICATION OF EXEMPTION
+ FROM REQUIRING A LAMA PERMIT
posourr-as and
r as autharizod by the Slgte of North Carolina,
the al
in a an of env o munie4 once n pursue ttol
ro 5 NCAC Subahapla 7Kl .02.03,Dorcas ommi9sion
Applicant tsame •,.l,a
Phone Number
Q 4
Address- 'g �•.J Zip' �f
Glly _ t -rz Stets ►J Lr
Project Localion (County. State Road, water Body, 8tc.)—
_ 23 t 0 4
LEA A-1-V
Type and Dimensions of ProjeGi _P-ti.�,—i!'� +-r
Tho proposed prajoct to be located and constructed as dasrXlbod
abovo is hereby cartltiod.as exompt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This 0tfomp4011 to
CAMA pflrmlt raqulromonts doao not Alleviate the necozzify of
ycur obtaining any other State, Fodaml, or [ ocai authorixatton,
SKETCH
Thin cortdication of oxornNiOn from raqulflt,g to CAMA porrnit is
valid for go days from the date of laaunnee. Fallowing axpiratlon,
B re-examination of the project and prOIAZ situ may be necessary
to conlinboihia cerliiic floe,
�ilb ri rS biS
Any parson who proceeds wish a dovolopmant without the con,
sent of a CAMA olfir~ial under tha.mintakon essumption thst the
dovelopment is examptod, A be in violation of 1ho CAMA ItthoTo
is a subsequent determination that a pormil was required for the
development.
Tho Applicant certifies by signing this axomption that (15 the ap-
plicca,It has rend and %WN abide by tho conditions of this oxomp-
tion, and (2) bwritten statement has been obtained from ad}acont
tnndowner•s certifying that thoy have no .objections to the
proposed work.
(SCALE; f "; Z D ' )
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Attachment IS North Carolina Adminisirative Codq 1K .o203
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