General Permits (7501)

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 �Kr-0�63.3r r Y
Eas 113
Applicant NamePhone Number
Address
City State Z'p
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project UU `
:?°-11* 5, r r..
/JS1 t3 A -1 03
The proposed project to be located and constfucted as described
above is hereby certified as exemptTfrom,the. CAMA permit re-
quirement pursuant to 15 NCAC 7-K 62"�: 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.
SKETCH (SCALE: )
r j 10 64 Io.t. or $'
r,
VJJa�
t ! 0
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 ofstair erlfrom-adjacent
landowners --certifying---that they. have- no-. objections. -to -the
proposed work.
Applicant's sign re
.rY ZZ
CAU Off ic al's s' nat re
'-7D�
Issuing`da e
6/3,/DQ
Expiration date
n I:-i
Attachment: 15 North Carolina Administrative Code 7K .0203