General Permits (2304)

CERTIFICATION OF EX
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources
in an area of environmental concern pursuant to 15 NCAC Si
1
Applicant Name L5 r� k
Address 2 r-
City n
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project _emu y- `i,
I Z X i l 0 A A ,{1 /t �-
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.
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA 4 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.
S E P 2 2 M5
S.Qommission
r •+K+w�ww�wgwn wr we!OMUfiY
Phone Number %li c� y `/ % L(
State il/ C r zip -/M '.-�-'r 0
r % �f1 % I� l
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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.
Applicant's signature
A
CAMA Official's signature
Issuing date
fi ...fin_ �•
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203