General Permits (5607)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resou_rces Commission
., in an area of environmental concern pursuant to 16^t&AC Subchapfer 7K :(T03. Gj&,A.a j40A A —
Applicant ame 1 i4e- Phone Number �� "� - -7 00
Address A rk i A
City se o State Zip
Project Location (County, State Road, Water Body, etc. I,}
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 alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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This certification of exemption from requiring a CAMA permit is
valid for -gym the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH C � J (SCALE: ) I
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150'
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.
LAMA-Unicial's sig{naatture
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Issuing date
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Expiration date
AttaeHrgtA 15-No�tb.,plina.Adr�i�i;�t��u