General Permits (1742)

O
CERTIFICATION O
FROM REQUIRING A CAMA P
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural
in an area of environmental concern pursuant to
Applicant Name u w
Address
City
Project Location (County, State Road, Water Body, etc.) _
.1h=t yr � C=u% �Gt Y� i ► t v 1'`. r v .` v ✓ P'�^ ;
Type and Dimensions of Project !Z 0
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.
r/t9TA1-L*Y, I-
Commission
Phone Number
State A.c Zip A
E-a 7" c' r i cry
u-1 A u ') f F a-r >
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 (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
landowners certifying that they -have = objections to the
proposed work.
Applicant's signature
CAMA Official's signature
Issuing date
I
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203