General Permits (5823)

O
Applicant Name
Address 6,
City
Proiect Location
CERTIFICATION OF EXEMPTI
*flAPR i 0 1997 i
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal R�.'lliTrC�S'Qertfm>sie�r••�•+•.
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
�� jn,. _r.k _ Phone Number-
,State Rqad, Water Body etc.) _
V s-�., i s � ..A -- 7
Type and Dimensions of Project .t ",
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.
State _
r
Zip
This certification 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.
I SKETCH (SCALE r:i,r'itiU )
Ll
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
CAMA Official's signature /
T
Issuing dgie
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203