General Permits (3917)

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C.'E.R-T4RjG-A-­T4QN"ZF EXEMPTION
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FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina, rc9l
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern purseaat-4e-46-NCAC-Stibe4apter 7•k-;0203.
Applicant Name
Address
City &,I
Project Location (Cou
Type and Dimensions of Pro
Road, Water Body, etc.)
State
Phone Number
The proposed project to be located and constructed as described This (rtification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid f ays from the date of issuance. Following expiration,
quirement p arat-4e-4,"6 f 2®3:-This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
4Cc - E'cd_ 'P'w es:
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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 written statem".,has:_baen obtained frorra-adjacent
landowners _.cst4ifying..thatr- hey. have no objections--w=*e
propaSedA.uoAc
" w .A
licant's 6iqnature
CAMA Official's signature f
r 6Z.3./f7(0
Issuing date
„_.I" .3 ! /19,
Expiration crate
Attachment: 15 North Carolina Administrative Code 7K .0203