General Permits (615)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT_
as authorized by the State of North Carolina, t �� �- T' �-' ' �,) t APR 19 i�g9
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name `:� yIN
Address_ . a %V�
City
Project Location (County, State Road, Water Body, etc.)
State
Phone Number 1'3.)- 15-A- s1X
0
0
Type and Dimensions of 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.
This certification of exemption from requiring a CAMA permit is
valid for 90Aays 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: )
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 -
CAMA Official's signature
Issuing date
Expiration date
Attachment:15 North Carolina Administrative Coda7K .0203..