General Permits (8300)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT-r"f'•�-ram'
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural, Resources and the Coastal Resources Commission
in an area of envir Wmental oncer puro ,' 5 NCAG—Subchapter 7K-:0203
e I�*
Applicant Name tl` ��' i'E�% �' Phone Numberf%'�`
a.
Address 7" k.V/ t , a' .c .
City - State � Zip _ �=
Project Location (County, State Road, Water Body, etc.)
! .G r' t�� •4 e' , R •. � �-^ a �-� . .
Type and Dimensions of ProjectX5
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.
Bit` d
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: )
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SFP 0 2 2011
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.
DcM M� CITY
Applicarft's signature
CAMA Official's signature
Issuing date f
Expiration date
Attachment: 15 North Carolina. Administrative Code 7K .0203