General Permits (333)

CERTIFICATION OF EXEMPTI
MAY
FROM REQUIRING A CAMA PERMIT I
as authorized by the State of North Carolina,���.--,L���--J1—�
Department of Environment, Health, and Natural Resources and the Coastal Resources-C>am"ssior�----------
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name C u
Address i C - fi
City
Project Location (County, State Road, Water
, etc.) 02
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.
SKETCH
l Phone Number (jz (c
State
zip 7� .
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.
I �
(SCALE:
U E
?-7 , r -
700
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.
Applicant's signature _� ,C ✓
CAMA Official's signature
Issuing date
Expiration date
I&
Attachment: 15 North Carolina Administrative Code 7K .0203