General Permits (7505)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT �7Vyj�
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of a ironmental concern pursuant to 15 NCAC Subchapter 7K .0203.
F//Applicant Name 11 / Phone Number
Address 5,f"/ t.-V4 i!V
City �Vr ,,'(.t1"'1Q State kie zip
Pro' A Lo ation (County, State Road, Water Body, etc.) .;' i ; ' =~ '� ? �I (�(r.�� /i i�/ice• ,
Type and Dimensions o 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 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.
M
Sl,
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: /fT,57 ) I
L �el nI E rlW7 Al 1 '-vr
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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.
Applicanr.d signature
CAMA Official's ignature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203