General Permits (6644)

CERTIFICATION OF EXEMPTION
Y
FROM REQUIRING A LAMA PERMIT
na aulhoritod by 15c 5tnto at tda; h Corcll'no,
M' Daporiment of enviro"merri, Hoalt.h, crd Natural Aoscurces and tho Coastal Floeourcos Commission \
r In nn area of onvlrpnmentai concorn pumverlt tD 15 NCAC Subchapter 7K ,02t33. S _ 6. q �,� bLFA*l
Applicant Nerrro —� P �A �x� Phone Number 3� ' s" f �
t.�-
Address
St;:te Zip
Clty
project Location (County, State Road, Water may, etc)
Type and Dimensions of Project
The proposed Prcied to tsa located and conatructod cis di;utibed
Ubov© is horoby csrtitied at, czampt iron 1ho CAMA permit M-
quiremont pursuant to 15 NCAC 7K .0=. This oxamption to
LAMA parmil rgqufremonla door not ailavtato the nocass(ty of
your obtaining any other State, Fodoral, or Local nuthcrii=ticn,
SKETCH
Th!s cartlll::t:cn Di ezomptlon from roqulring a LAMA p©rrnit is
vral'.6 for S0 days trzm thO dc: Q of isaurance. Fcllowing oxpirntion,
a ro.G2sMln®lCn of th3 pi o ft and project sN® may be noceasnry
to continuo this cortlNcatlon.
(SCALE;
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Any paraen who pracoode with a development without tho cOn-
sant of a CAMA ofliclal under the mistakgn 38eumptfon that tho
riripted, will in �Aolaflcn ol tho CAMA
a n lop gquortt dat rmfnotbnbtchut a porm t was raCu! ©dllothhe
development.
The applix;ant certifies by signing thb oxOmPOOntirat 0) tho op•
tion at d (2 readwritten statternent hide as boon obis rod 1 mna Of ls OxOMP-
adjacan
iron, wft (rn a In that they haya no obf�ris to iho
Inndownera cortfty g
proposod work.
T/T"d 92969)'MoS:01
ro
.
f~ayuing date
E)tpbmlon date
AttaGhment_ i5 North C,,(,UnEt Administrative Cade 7K "0203
;wo�� 9P-:f'T L002-60---Tq-�