General Permits (5552)

ft.t I r Y
CERTIFIGATION-.OF EXEMPTION
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FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina, /� t d Ce
Department of Environment, Health, and Natural Resources and the Coastal Resources Comrrfission
in an area of environmental concern pursuant -to 15-NCAC Subchapter 7K MO.
Applicant Name f
Address ..-'-, 7
City :t ,f,:c;r r�
Project Location (County, State Road, Water Body, etc.)
r
State
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 re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not••alleviatelbe-necessity-of
your obtaining any other State, Federat, or -Local authorization.
Phone Number��-
Zips ' 4,70
This cerffication_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.
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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 has been obtainedfrom adjacent
landownerscertifying that they have no objections to. the
proposed -work::
ppLcant's sigpfiture
CAMA Official's signature
h.
Issuing, dater
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203