General Permits (3124)

CERTIFICATIO OFEXEM I ;ON
FROM REQUIRING A CAM*APM1+
as authorized by the State of North CarolinalJUP—
Department of Environment, Health, and Nakw&, i1
in an area of environmental concern pursuant to 15
Applicant Name b Alm J. L/` 1
Address f �/
City t ? C t) C A
Project Location (County, State Road, Water Body, etc.)
1)
JJ kJ / tJ -F
Resources Commission
Phone Number ,j ) - S J 3 _/_ 7
State ' 1/'C'- -_ / 4 Zip;4 "
�V f�Ui rlJ T A L P? ,_- 'fir AJ1 L Su
Type and Dimensions of Project '_K J �' c j �!7 �r X �-
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 c(-rtification 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.
SKETCH -) T L ( L i "<_i (SCALE: )
`41 0f1
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
wi-t t 1►7
CAMA Official's signatLde
Issuing date
Expiration date °
Attachment: 15 North Carolina Administrative Code 7K .0203