General Permits (7467)

Applicant Na
Address
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 are_a/ of environmental contemn pursuant to 115 NCAC Subchapter 7K .0003.
Phone Number
City M : i . 17,A, - -
Project Location (County, State Road,,Water Body, etc.)
State zip "',
Type a d Dimensions of Project�f�
,tT � �, C .. -ter �yi''� . G9�f //l '�' � � ;•�'; �� �
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 .0,-03. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid for 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.
I SKETCH (SCALE: )
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.
1135)
=For
Applicant's si ,pre
�t-
CAMA Official's s' na e
Issuing date /
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0,2`03