General Permits (2585)

Applicant Namei
Address -
City t°``.
Proiectlocation (Cbi
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CERTIFICATE OF EXEMPTION (( FROM REQUIRING RE UIRING A LAMA PERMIT
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as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission LIZ
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K • ! `: `-= -;•
CCZYY1�Si}� guts-,h�l-' '"1j Phone Number
, State Road, Water Body, etc.)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit
requirement pursuant to 15 NCAC 7K = i v . This exemption
to CAMA permit requirements does not alleviate the necessity of
your obtaining other State, Federal or Local authorization.
State
sm
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This certification of exemption from requiring a CAMA permit is
valid for900'days 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: ; �a a )
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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 signingwthis-axe ption-thatjt�.the
aP­_
plicant..has ceadattid.wal:abide by-the-eonditions--of-thls_exxernp-
tion, and (-2)-awritten-staternent has been obtaine81r3ut2djaeent
landowners- certifying that -they : have --no robjeetiGns--to-Ue
proposed -work.
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Applic bars signglure �.
CAMA Official's signaturo(
Issuing ate
Expiration. date
Attachment: 15 North Carolina Administrative Code 71(aICS