General Permits (864)

CERTIFICATION OF EX
If FROM REQUIRING A CAMA PERMIT MAY 2 4 2001
as authorized by the State of North Carolina,
1 Department of Environment, Health, and Natural Resources anc th-t5_ RAwaftgsWmmission
in an area of environmental concern pursuant to 15 NCAC Sub JJA JEMR __
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.
1 i Y Y )
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.
Phone Number'`�l
State Zip
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 T (SCALE: )
r
i Af
f r � f!f 7 1
I
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.
Appl-16ant's signature .
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203