General Permits (792)

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CERTIFICATION OF EX
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources
in an area of environmental concern pursuant to 15 NCAC S
. c.1 Q Y
Applicant Name
Address
t r
City %,"N ,; _. •"',
Project Location (County, State Road, Water Body, etc.)
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.
SKETCH
,1 5
AUG 3 1 2001
,i,` 6a .N:i .'e,�i�lali NCo mission
ter MO ' AD
Phone Number
State (_ Zip
� "0.} :]� �..tq'�i:_l'-'C.STI•_ 1•\ � ,'sue. ,� Z-.
.s. •ate i
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.
(SCALE: i"';'.: ' )
M.=
tip,. 4 '4t In Pr. '\- •-, i..� _: 5 ,^ { i
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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.
A pi cant-s signature
CAMA Official's signature'
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 o f ,y OQy'm �iic\.�, � .)
landowners certifying that they have no objections to the Expiration date ; f/
proposed work. ^
Attachment: 15 North Carolina Administrative,Code'7K .0203
Issuing date

MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
G �
PERMTTTEE' S NAME: PERMIT # O
LOCATION:
La � N�� LL da"-Wa FIELD REP.
PHONE: DATE REPORTEDLY COMPLETE:
DATE OF INSPECTION
i
1) Do the easured dimensions of t e development differ from those indicated in the permit and workplat?
YES O [circle one].
COMMENT:
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? YES/NO [circle one]
COMMENT:
3) FUTURE MONWORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? Y [circle one].
COMMENT: