General Permits (2310)

O
�1
CERTIFICATION OF E
FROM REQUIRING A CAMA PERM
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resourc
in an area of environmental concern pursuant to 15 NCA� _
Applicant Name K t) e r v_u rtr I
Address s C' e
City<� t
Project Location (County, State Road, Water Body, etc.) . D e,.,
u wn. ;�� Oct✓ r_
and Dimensions of Project
V 3' SA D0(0 V, A )p n 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.
ission
AfflNr�r r� •�rr�w-00"'e�w44w
rl-
r, .: Phone Number t � 00
State kJ
C._ Zip
G i) 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.
I SKETCH �`"� a cF "o uuc�•�(SCALE: )
4 '
pa,lk
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.
Applicant's signature
CAMA Official's signature
I"f-7S
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203