General Permits (3126)

CERTIFICATION OF EX
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources
in an area of environmental concern pursuant to 15 NCAC S
Applicant Name t e,
Address `
City s-, fs-fi,r..
Project Locatign (County, Slate Road, ;Water Body, et2J. %(; '7 i
and Dimensions of Project
A 1 i• S .
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.
T- -1 I`/I r/
MAR 2 7 1997
ion
Phone Number
State N (� _ Zip
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.
SKETCH 6 - (SCALE:
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.
t `K i!} , S��- i(V-\, o
Nb
Appl icant'ssig n,atura,
R
CAMA Official's signature
a A Ls
Issuing date j
Expiration date'
Attachment: 15 North Carolina Administrative Code 7K .0203