General Permits (2068)

r
+ RECEIVED `' lE,
CERTIFICATION OF EXEM , ION28
FROM REQUIRING A CAMA PERMIT Olt
as authorized by the State of North Carolina, DC
Department of Environment, Health, and Natural Resources and the Cog,
a IR%Ziil`ces'Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Namef5ir�tt tom? trt ,�(L i y Phone Number i
Addresst,j Ant T -1 t ".
City ; ,v;; j - State zip 7M
Project Location (County, State Road, Water Body, etc.) -A'
Type and Dimensions of Project rz_ u-1
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 c�­tification 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 i,'-7 - a.+. (SCALE:
i("'
t'a
0
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,writtenstatement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
u
Applicant's signature"
CAMA Official's signature
Issuing date1
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203