General Permits (5848)

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s -CERTI FICATION ' CIF EXEMPTION
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REQUIRING A LAMA PERMIT �
as authorized by the State of North Carolina, co
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pw*swmt7to--1" 'C Subchapter 71<°.0203.
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Applicant Name ; f Phone Number 724 -
Address
City
Project Location (County; State
Type and Dimensions of Project�
ad, Water Body, etc.)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pumarttto AFMAC -Mr: 283. 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�9011ays 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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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) awrittenrstateTnent,hesbeen-obtaineditom adjacent
landowners- certifying--that-they have --no objections -"to the
Pmposed-work.
cv-
Applicants-signature_
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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809 BRIDGES STREET POST OFFICE BOX 3648 MOREF;EAD CITY NORTH CAROLINA 28557 919-726-7091
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