General Permits (585)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, � Q 7 ZQOZ
Department of Environment, Health, and Natural Resources and the Coastal ResouFcaycommission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name c '
Address
City 1 w
Project Location (County;
Phone Number 7y — 543 ` 1 � /
State Zip Z
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid,for 90 day_orom the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
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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.
I
Applicant's signature
signature
.,s -?✓li � Ifs
Issuing date 4-SC.,.: A&:X
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203