General Permits (7647)

CERTI
FROM REQ
as authorized by th
Department of Envi
in an area of enviro
(CATION OF EXEMPTION
UIRING A CAMA PERMIT
e
State of North Carolina,
ronment, Health, and Natural Resources and the Coastal Resources Commission
nmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name I ff , f�` r `
Address
City
Project Location (County, State Road, Water Body, etc.)
,
r5lri• Phone Number Z. ;� -- >5,/e /
State
Zip
-t, t'
Type and Dimensions of Project. _ J��. / %� /r, � tom. //,," ;!' t-i _"
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 :020,3. 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.
�-C�? � 09 It
SKETCH (SCALE: A/ 7 r ) 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.
Applicant's ogn,ature
CAMA Official's gnature
Issuing date
f�
Expiration date
Attachment: 15 North Carolina Administrative Code 7K -0203-