General Permits (1789)

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CERTIFICATION OF
FROM REQUIRING A CAMA PER I T
as authorized by the State of North Carolina`
Department of Environment, Health, and Natural ResowGc&&ef�6#heOoast rl-R'§so"urces Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number 7
Address
City )._-c-Wto Zip 2,8 46
Project Location (ounty, State Roa Water Body, etc.) -2 2 _ t Li c
Cl, ( ufJ
l
Type and Dimensions of Project o K,#_ V-f M i fcx
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 g0 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: I• r R q r )
'V
f s'
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.
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2
CAMA Official's signature
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Expi ation d to
Attachment: 15 North Carolina Administrative Code 7K .0203