General Permits (1853)

CERTIFICATION OF tX.EIIPTO
FROM REQUIRING A CAMA PER ITAuG 11 y
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resg rc_e—sgAUfti0o�� es Commission
in an area of environmental concern pursuant to 15 NLA,C.-SubchapterZK.0203.., w
Applicant Name O F} ti NA M aA K 1
Address 16 Q A C A k-L A XJ b N
City R q f f 4 N
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
o f .- .'rw. -
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.
Phone Number 9/ `j a 4
State c Zip
' �. c 7 (.
G • ti, c iu 11tN e Nf1 L
u so/2 ." J o , r- 57 f - C7'
G , X /` g! Arx- .
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.
MONSON
ON
0
�1
-
R
■
!
MUMMIES
sir+
WME
MENEM
na
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.
i .f P,, Nul , j 71 _,7c
Applicant's signature ( .
/97 e
CAMA Official's signature
00. r .. 9(4,
Issuing date
// -r _�7 — cl)L
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203