General Permits (7463)

O
Applicant Name
Address
City'
Project Location (C
At o4 a G t4 r
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, i
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC-Subchapter-744-02a3_.. ,U' J'0 3
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Phone Number'0— 1c1
State Zip :2 3 J 3
)unty, State Road, Water Body, etc.) Qr4it' L Cc�un/-r7
a
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 1`s NGAO-7K :0203:-This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
-
A,l-
This certification of exemption from requiring a CAMA permit is
valid for 90days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE:
btr�`t r Cyr''
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9� ' J'e�-
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) awritten-statementhas-beenobtained-from adjacent' --
landowners- certifyang -that--they -have-no objections to the
propo ed.work
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72�
Applicant's signature
CAMA Official's signature
"21��: �-
Issuing date
Expiration date
Attachment: 15-NorttrOa otirra-Administrative-Code 7K:0203