General Permits (3)

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CERTIFICATIO 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 Commissionb�
in an area of environmental concern pursuant to 1-SNOAC Subchapter7K .0203.
Applicant Name �'Ya �1 Phone Numberooz
Address
City State Zip s S r
Project Location (County, State Road, Water Body, etc.) -
Type and Dimensions of Project
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_NCA67K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
,&C6> "/ - / c7 �S) 0) ti )
SKETCH 0 H
This certification of exemption from requiring a CAMA permit is
valid forto days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
C f r! r
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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 hasbeen obtainedr6rn adjacent
landowners -certffying that they- have no- objections -to the
proposed work: ._
s
Applicant's signature
'� z
CAMA Official's signature '
I )Oo�
Issuin date
Expiration date
AttAc}imant: 15 North Carolina Adefiinistrative Code 7K :0203