General Permits (8063)

L9UL
r' iCERTIFICATION OF EXEMPTI
1992
FROM REQUIRING A LAMA PERMIT�L jL) j
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resqures.CQovaissioR------------
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
Address
City �-
Project Location (County, Statepoad, Water Body,
Type and Dimensions of Project , i 1
The proposed project to be located and constructed as descbed
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
yo r taining any ofer State, Federal, or Local authorizationIk
SKETCH Ft-7 %—
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.
State
Zip;7S �
This certification of e&6mption 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.
e
(SCALE: i a )
Applicant's signature J
CAMA Official's signature
Issuing d
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203