General Permits (5860)

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CERTIFICATION OF EXE I .
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FROM.REQUIRING A CAMAPERMIT:
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal RescttJfces Commissao,
in an area of environmental concern pursuant to 15 NCAC Sub hapter 7K .0203. I_
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Applicant Na
Addre s
City State ZIP D
Projec Loca io Courpty, State Roa Water Body, etc:)
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Type and Dimensions of Project
The proposed project to be located and constructed as described ' This certification of exemption from requiring a LAMA permit is ,
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant ;to 15 NCAC 7K :0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not, alleviate the necessity of to continue this certification:
your obtaining any,other State, Federal, or Local authorization.
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 Applic 's signature
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development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the CA Official' sign t re
development.
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The applicant certifies by signing this exemption that (1) the ap- . Issuing date .
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 Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203

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