General Permits (6436)

CERTIFICATION OF EXEMPTION ---_,
_Y FROM REQUIRING A LAMA PERMIT -`�- L==`'�L T( i
as authorized by the State of North Carolina, —' I
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to-15 NCAC<Subchapter 7K-.0203.
Applicant Name U cr tri U�\ Phone Number `� 11� -GO- -`WIG
Address X
City State Zip 7
Pr�ject Location (County, State Road, Water Body, etc.) C C� t 1� pc
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.
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.
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
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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CAMA Official's signature
Issuing date
Expiration date
Attachment: 15-Nort4-Carolina Admn-infstrattVe Cbde-7K .0203-