General Permits (890)

-Y CERTIFICATION OF EXEMPTION AA
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FROM REQUIRING A CAMA PERMIT� �r;,1
as authorized by the State of North Carolina, " '1i `7U
Department of Environment, Health, and Natural Resource0 f tl1k qo" esources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter M0 03. /
Applicant Name v rti 1�,f� Phone Number
Address to S 1, �-
City State Zip V
Project Location (County, State Road, Water Body, etc.) r'✓�, �y t"
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.
A
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 i (SCALE: )
ti^ All w'
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.
t
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Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
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Attachment: 15 North Carolina Administrative Code 7K .0203