General Permits (5564)

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-Y- CERTIFICATION OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
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
Applicant Name S-r^, �,J �— Y Phone Number )C�>-7C��
Address le 0 gnu �—�
City State Zip
Project Location (County, State Road, Water Body, etc.) ! T , , , - 2 7!�-7
O C
Type and Dimensions of Projects AC
,
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement p��La�ant +�-+� �, �3� This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
This certification of exemption from requiring a CAMA permit is
valid for mom the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE: iiiON
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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 obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
Applicant's signature'
�_icjja�6giq>tre
Issuing date
1 a� I L\l I c1 Ct 7
Expiration date
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