General Permits (3256)

R 0CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT U t+
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the C
in an area of environmental concern pursuant to 15 NCAC Subchapter .,n„aacsaapasItWANM
Applicant Name " W e o A e �L 1 Phone Number :-' 1 - e %`��
Address > ''i iz
City A V ta r e.A State i/ cam-- Zip :9 t (/
Project Location (County, State Road, Water Bodyetc.) z L� �l� K. (�; �, ��'a' Iri '� V ,
Type and Dimensions of Project !�E f LA CF "1 of,
V atT-F-tJ 5 7' 1 bl tic, .
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.
z 'r.,Oc , r,4 6„ T d 1 F 7-, evC c 7 /� A; & 5
V VY�:�7M �� �' O uS7rCtrG� U
�� X7 qrl_, CHAFiO �"-�,T'r1 1NofiFtcw7�oV
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 UJ ! v:. ' .. o ._ . ; <� `.. (SCALE: / "r, of o � )
1
i f) ' 21!-T
� j NG PAA"r o `,%ov7fr-Ir `;NAl./
L-.i»`
7U r<t L9t_r',1l r�i EF it'f•5iC/.M--'14�-4.iF - x T't�u G.c. � rrfnN I To
+,: VC i C.�� .'i. Sr?.+*w' ACT. AdcCt S l.X)!:`XaoycPK.
.7_
vuF,& ri vii i e oiCgEl= Iwo
A0PINGAk OF- /C .• T
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.
?1 c fA,eT 1F OOCKS, G►1 XAO o
Sr1Nv_� fit= Cc+N�iT
ov JErc ta+0TLA&,DS i I V
� h �
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203