General Permits (1698)

O
CERTIFICATION OF E� � �-'P``
FROM REQUIRING A CAMA PERMIT j' AUG Q 9 i3303
as authorized by the State of North Carolina, jj1`,�� 9
Department of Environment, Health, and Natural Resource;�oq�` ` IaI Fjesmurces.Commission
in an area of environmental concern pursuant to 15 NCAC SLJxl1ap1"ZK0203_____
Applicant Name h,
Address z VLF
City t' t
Project Location (County, State Road,
r Body, etc.)
t C L, Phone Number ^rii 2 —_.�-�`5 Z
State, , AJ C Zip
Type and Dimensions of Project a w — �, — c t-
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.
5
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 j~ C (SCALE: / )
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 signaturb AZ
CAMA Official's signature
Issuing date';
l
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203