General Permits (7731)

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CERTIFICATION OF EXEMPTION
_Y FROM REQUIRING A CAMA PERMIT ZD00
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 1-5 NCA£ "Subchapter 7K -.02.03.
Applicant Name
Address
City :.
Project Location..(County,
Road, Water Body, etc.)
Phone Number "' ;3ov
_ State NC. Zip
4
Type and Dimensions of Project e 0 t, ; : v cc' x e < c�. 1 � x i �' n 1) .T rn
_,
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 M :02t . 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.
SKETCH (SCALE: Nc no_- )
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C iae t eprw d
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.
r
Applicant's signature
ff
CAMA Official's signature
/1 `1 9
Issuing dat4
Expiration' date
Attachment/ 15 North Carolina Administrative Code-M-10203