General Permits (2617)

-Y CERTIFICATION OF EXEMPTION E�
FROM REQUIRING A CAMA PERMIT NoV I ,ZO
as authorized by the State of North Carolina, tr �,
Department of Environment, Health, and Natural Resources and the Coastal Resources CoA44n
in an area of environmental concern pursuant to 15 NCAC S.ubchapter-7K-.020 . >A -.
` Applicant Name ('' c i tt_ , C)vt rPhone Number('�s
Address�t{t+
City { '' " State zip�
Project Location (County, State Road, Water Body, etc.)
c
Type and Dimensions of Project E ; I -;{ , .� �" =t { i ti a i. x It 4,
�tc�.r•/:w,..-,�a� �r i1,er! <.. +'.� GAS
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 certification of exemption from requiring a CAMA permit is
-valid-fdr 9b days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: )
A y ` 1 `
9.!
Q vt V
a err/�/J
Lt v�Z t�cQlau ^ 31i; X H
r
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--objecttorrs--to-the-
proposed work:
Applicant's sigpature
CAMA Official's signature
Issuing date
Expiration date
.Attachment--15 North-Carofirra Administrative -Code-7K-0203---