General Permits (7617)

' y 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 7K .0203,
Applicant Name _
AddressQ
City {+
Project Location
State Road, Water Body, etc..). r-tQ r?
State
Phone Number 'I (`1 ` 1`,S I- '70 5
o-N,�ar
Zip
Type and Dimensions of Project "� ` x NN -i -C'c f• ?,
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.
C
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: )
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 objectiorts...to. Ahe. _.
proposed work.,
Applicant's signature ✓
CAMA Off icial's"signature
Issuing date
Expiration dat
Attachment: 15 North Carolina Administrative Code 7K .0203