General Permits (1922)

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Applicant Name
Address i;
City „, j ,
Project Loeation
i,1,) i i It 11 11 �
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
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.
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(County, State Road, Water Body,
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 ,.0? . This exemption to
CAMA permit requirements does nofalleviat�e the necessity of
your obtaining any other State, Federal, or Local authorization.
213
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 SKETCH (SCALE: N'� )
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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-writ-ten-statement-hasbeara.©btaifted-from-adjacent
lattdomnxififyingthat--+hey---have—na--objections•-to the
-proposvd-work-:
a
Ex
iature
Hwr'l Wei
Attachment: 15 North Carolina Administrative Code 7K .0203

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Applicant
City
CERTIFICATION OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
ao authorizod by Iho SWO of North Carolina,
00padmorlt of Environment, woatth, and Natural Aosowtced and th0 Caaatal Res0urs09 Camrnloston
In to aria of anvlronmonial concorn purnuent to IS NCAC Subchaptor 7K CAI
AAK*-.t'hnn -h AA C/D A�A M-0-&1vttn_ Phone Number
State Ftogq, Water Body,
Zip
'Cho proposal prbJdct to be Imted and donttructod as d40artbed Thin cartRlaation of OxamptIOn from requlring a LAMA p®rmit la
abCVa to hereby aanitlAd no exempt from tho hla eeperrltlntroa Ula�expmonat n of the dnylkom adject and project siFe im y be necessary
quirs5ment pursuant to 15 NCAC 7K �� P
GAMA p�ermlt requlraments does not l a the nocaaslty of to oontlnueihis oadtllaation,
your obtnining any other State, Poderal, or t,aaatl authorization,
(SCALrz; )
SKETCH
Wow
'! Nr -HeA
Any parson who prpoeada with a dovatopmant without tho ccn•
sent of a LAMA ofticigl undortha mistakon ausumPtlon that tho
dev9lopm 9nt to oxemptod, will be In violation of the LAMA It thora
is 4 sub00quent dotarmindtfon that * pormit waR requlrod for the
developrrtgnl.
,"no opplicant 0prtlt)os by oigning thls exvmPtlan that (1) ttlo ap-
plicant has read and will abldo by the coodlilona of Ibis axemp,
tlgn, 4nd
I
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0
Attachment.15 North Ca►ailnn AdrnhatrativO Coda ?K .0203
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