General Permits (3470)

CERTIFICATION OF EXEMPTION
"Y FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina, JUL 1 `
Department of Environment, Heaeth� sursNant to 5eNCAC Subsources chapter 7Kthe t 0 03 al ources Commis i T�
in an area of environmental cone p
Phone Number �q
Applicant Name v
Address State Zip -�
City Iof a ti
Project Location (Cou t , State Road, Water Body, etc.)
Type and Dimensions of Project
echo be and constructed as described This certification s from the date of issuance! Follow n from requini ng expiration
The proposed prof permit re- valid for Y
above is hereby certified as exempt from ,the CAMA P to 'a re-examination of the project and project site may be necessary
quirerrient pursuant to 15 NCAC.,7K .0203. =This exemption., to continue this certification.
CAMA permit requirements does not alleviate the necessity of S I D�
your obtaining any other.State Federal, or Local authorization. �� /\
(SCALE: )
SKETCH
C7 Q
opt b - --
l -c r
An person who proceeds with a development without the con- lic n s s re t
Y
sent of a CAMA official under the mistaken assumption; that the I Gt! �VLc "77
development is exempted, will be in violation of the CAMA rf there _
is a subsequent. determinationthata permit was required for the
CAMA al's signature
development
The applicant certifies by signing this exemption that (1) the ap Issuing date°
plicant has read and will abide bythe conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the Expiration dat
proposed work. ,. Attachment: 15 North Carolina Administrative Code 7K .0203
E _