General Permits (759)

Applicant Name
Address
City
CERTIFICATION OF
FROM REQUIRING A CAMA PER
as authorized by the State of North Carolina,
co
Department of Environment, Health, and Natural Res c urs
in an area of environmentaLconcerq pursuant to 15 NC
So n
IU1
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.
' L_
AY 07200
(--c
PO 414
Commission
Phone Number "A I (; "1 �f'1- (41 q II
Zip Z.f, - DES
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.
I SKETCH (SCALE: NUT ) I
M_n ci
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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.
Applicant's signature
CAMA Official's signature
Issuing date
I z
Expiration date
1
Attachment: 15 North Carolina Administrative Code 7K .0203