General Permits (1716)

CERTIFICATION OF EI`f
FROM REQUIRING A CAMA PERMIT MAR 2 - 1
as authorized by the State of North Carolina, o j
Department of Environment, Health, and Natural Resources] atu�1 Sh—siaD mission
in an area of environmental concern pursuant to 15 NCAC Subchapter2K_02,02.______,,..,,
Applicant Name G�.� Phone Number
Address e,
City State zip
Project Location (County, State Road, Water Body, etc.) Co 4` 1 �a �:
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.
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: \ _ _ )
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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
Jandowners;_certifying that they have. no . objections to the
proposed -work.
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Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 74<•-.0203