General Permits (2165)

Applicant Name
Address
City
Project Location
RBCiriVED
CERTIFICATE OF EXEMPTIONUG 2 7 2012
FROM REQUIRING A LAMA PERMIT o.2 092.99214
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources ComWirsssion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .
unt-y, State Road,
Type and Dimensions of Project
State
Phone Number 26-2` 21- 9$ 3
Zip
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 valid for 90 days from the date of issuance. Following expiration,
requirement pursuant to 15 NCAC 7K . This exemption a re-examination of the project and project site may be necessary
to CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining other State, Federal or Local authorization.
t I
SKETCH (SCALE: ` _ `It/
C
o WAS N
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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(I(Nor S&WN)
suing date
Expiration date
A4tae11i41erH'-1-
ture
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