General Permits (6364)

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Applicant Name
Address
CERTIFICATION OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina, MAR 16 1999
Department of Environment, Health, and Natural Resources and the Coastat-Respurces Commission
in an area of environmental concern pursuant to 15 NCAC Subchaptdr.,7K .0203.
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Pro ect Location (County, State Road, Watt�er Body, etc.)
Type and Dimensions of Pro'et _Ai Go�iri /a
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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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k f/•f a P 17 K, a A� 3 54.11 -IMP14 This certification of exemption from requiring a CAMA p rmit 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.
SKETCH (SCALE: Ak- -- )
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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.
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Applica s ignature /'-� J 2(
CAMA Offfial's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203