General Permits (8241)

O
Applicant Name
Address
City f.
Project Location
CERTIFICATION OF EXEMPTION
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 pursuant to 15 NCAC i­ch`apter7fC :'0203�— / ,If lt***�-7
Phone Number `i1%7-`�
:ounty State Road. Water
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.-NGAG-74(-:020&.-This exemption to
CAMA permit requirements'does not alleviate the necessity of
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.
State zv, c Zip
f
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.
)2 n +
Applicant's signature
CAMA Offi ial's signature
4r
issuing��/�j.
Expiration date
Attachment: 15 NorthCarolinaAdministrative-Eede-7i(-•e2QG,
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