General Permits (345)

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Applicant Name
Address
City
Project Location
CERTIFICATION OF EXEMP I " 5=
q FEB 0 3 1993
FROM REQUIRING A CAMA PERMIT '
as authorized by the State of North Carolina, �� A
Department of Environment, Health, and Natural Resources and the Coastal -------
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
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Phone Numbers
(County, State Ro
_n
Type and Dimensions of Project
Water Body, etc.)
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I t °
The proposed prof cctt 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
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This certification of exemption from requiring a CAUA permit is
valid for g0 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 SKETCH (SCALE:
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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 has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
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Applicant's sigotbre L -
CAMA Official's signature
Issyf g date
Expiratiorti date
Attachment: 15 North Carolina Administrative Code 7K .0203