General Permits (4128)

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CERTIFICATI,O,N OF EXEMPTION
FROM REQUIRING A LAMA PERMIT (0
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant- to- 15 NCAC Subchapter 7K-.02G3.
Applicant Name�rti��„�; ,eve• -
Address /4 C
City
Project Location (County, State Road, Water Body, etc.) _
Phone Number
State .zi
Zip !:�.ES h�
Type and Dimensions of Project
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to-15 NCAC, 7+<-.0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This ceirtification of exemption from requiring a CAMA permit is
valid for W-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: )
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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 statement h'as' been obtained from adjacent
landowners certifying that they have no objections-- to--.the-
proposed work.
Applicant's signature
CAMA Official's signature
Issuing date
7
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203