General Permits (7776)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT 'r'L`-- "k
as authorized by the State of North Carolina, �� �'
Department of Environment, Health, and Natural Resources and the Coastal fkis' `Grces Commission
in an area of environmental concern pursuant to 15-NACA6-Subchapter-7K::0203.
Applicant Name fr
Address
City
Project Location (County, State Road, Water Body, etc.)
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Phone Number(,J) yu�/-��/c'✓
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Type and Dimensions of Project r�: 1 P l� -<�: f�' t r° ' art 1f� F�/>'
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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-71K .0203: 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 0 ' C� _ (SCALE: ) I
Hlly pui lull NVllu pluI'Zm;0 rrull a u-_V... a •.w w..a ... ......
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.
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Applicant's signature
CAMA Off ici s signature
S
Issuing Mate
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203