General Permits (2602)

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .
Applicant Name
Address
Citv
Project Location (County, State Road, Water Body, etc.)
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
requirement pursuant to 15 NCAC 7K . This exemption
to CAMA permit requirements does not alleviate the necessity of
your obtaining other State, Federal or Local authorization.
State
a 0251
Phone Number
Zip
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.
development is exempted, will be in violation of the UAIVIA it mere i
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
i ,
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.
Issuing date
Expiration hate
Attachment: 15 North Carolina Administrative Code 7K

J U L 2 2012
CC)AS T AL 1,1ANAGEMENT
ELiZABE T H CITY