General Permits (7613)

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 r_
in an area of environmental concern pursuant to 1-5 NCAC-Subol}apter 71K'-0203.
Applicant Name ; 131 i
Address f,,ce
Citv -
Project Location (County, State Road, Water Body, etc.)
f
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.15 NCAC 7K .0203.-This"exemption'to
CAMA permit requirements does not alleviate the necessity of
ryour obtaining any other State, Federal, or Local authorization.
State
Phone Number �i/.1,' - Xr- Ll=
Zip
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: , . ) I
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.
1
Applicant's signature /?s�
CAMA Official's signature
,�L f he
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203 .