General Permits (2579)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, II I�
Department of Environment, Health, and Natural Resources an a al urces Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name `'Fn �.��� h"+ lc.c / 7r' Phone Number �ia,0
Address :�4'0 t/ r Cr��.t "�,-J_J
City State A)0 Zip c/s
Project Location (County, State Road, Water Body, etc.)
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .020q. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue thus -certification.
your obtaining any other State, Federal, or Local authorization. U��
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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.
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Applicant's sl nature —>�
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CAMA Official's signature
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Issuing'date
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Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203