General Permits (8012)

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CERTIFICATION OF EXEMPTION-��3�/�
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 pVsuant`to 15 NCAC Subchapter 7K .0203.
Applicant Name
Address 4 9f
Phone Number I��, 9f 72
City "'., - ,; A, ,,,f. ;
Project Location (County, St to Road, W e Body, etc.)
State loy/,
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Zip �.
.T.r
s
Type and Dimensions of PrTjpct
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.
�. 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: /,, 7 )
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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
CAMA Official's s gnatu e
Issuing date
Expiration date
-f _ /4n
Attachment: 15 North Carolina Administrative Code 7K .02'03

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