General Permits (322)

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Applicant Name _
Address 'Z:s`
City
Project Location
CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, LDoru-�,J I
Department of Environment, Health, and Natural Resources and the Coastal Resources mmission R :/
in an area of environmental concern pursuant to 14 VCAC Subchapter 7K;,0203.'JJ�rrr�r*+ar-
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e-T, C -A r � o S �-�n-.���t--�N�.ti,-, Phone Numb r
,State tRoad, Water Body
Type and Dimensionabf 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 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
e
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.
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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✓/ 1 V - w r
Appli is Sig ure
CAM Official's signature
Issuing date
Expiration date
Attachment: 151North Carolina Administrative Code 7K .0203