General Permits (2351)

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CERTIFICATION ' 'M.4.31 oN a, i
FROM REQUIRING A LAMA
as authorized by the State of North Carolina,
Department of Environment, Health, and Natu
in an area of environmental concern pursuant
Applicant Name P I,r t
Address r
Cityr-
Project Location (County, State Roa , Water Body, etc.)
Type and/ Dimensions of Project U04 s f r v c-t-
���Y/`n t .f✓ k;f". J � :fin Aro,g
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 otticial 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.
WIN Q 9 1995
n " ources Commission
C Subchapter 71� jQ
Phone Number
State T Zip
w�L % �o.Ib SUS o o A. 14-"Id,
S 4 N I i6 Y, i Ct-
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.
Appncanrs signature
CAMA Official's signature _
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203