General Permits (923)

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CERTIFICATION OF EXE lover BasinBntil
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FROM REQUIRING A LAMA PERMIT Please contact DeborahSawY
946-6481. �� }
as authorized by the State of North Carolina, = N `U J
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Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subehapter_7K 02Q3.
Applicant Name -3 a
Address 'k; 5
City
Project Location (County, State Road, Water Body, etc.)
Phone Number _ cQ— ! b&-()
Zip
Type and Dimensionsof Project t rxXr Nti c Cs)c;, _t ck �1', :?�S" 1�„„ 4 �tr L-J, 41,
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1-5 NCAG 7K-.0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH .41Fr =-7
ppe
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.
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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applicant's4ignature
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-CAMA Off icial's'si nature
Issuing date
Exp�n date
Attachment: 15 North Carolina Administrative Code 7K .0203