General Permits (7717)

Applicant Name
Address
CERTIFICATION OF EXEMPTION-- -
FROM REQUIRING A CAMA PERMIT "
as authorized by the State of North Carolina, (�E�±
Department of Environment, Health, and Natural Resources and the Coastal es ur e C ssion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
i' % NA � �5�� � N � Phone Number
City " i ? t -. 7' 1" r n r'J State
Project Location (County, State Road, Water Body, etc.) (_ u r-tL# T c. c.k
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
your obtaining any other State, Federal, or Local authorization.
Zip-211/
4
V
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 E -5 (SCALE: V6pr ) I
I
' t
4
G ;ry
r T/
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.
nat
CAMA Official's signature
Issuing date
AAAf- 'I-c Gr;
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203