General Permits (284)

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Applicant Name
Address 3
City —
Proiectlocatiop
CERTIFICATION OF EX PTIO turces-ommission
��FROM REQUIRING A CAMA PERMIT /AN 12 1993as authorized by the State of North Carolina, LJ
UDepartment of Environment, Health, and Natural Re§ources and the Coastal Res
in an area of environmental concern
jpursuant
'toI_15, ;NCAC Subchapter 7K .0203.
1 L_� is r c k e �/d C� rt y,(�-�c Phone Number
State Roacj Water Body, etc.) t 1 1 L U
Type and Dimensions of Project !-- Ir u-A k4.
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.
State
Zip 2--817�
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: ' )
t STE nt�
I Luy"g�c m
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.
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LAMA Utticial's si nature
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Attachment: 4North Carolina Administrative Code 7K .0203