General Permits (3746)

O
CERTIFICATION OF E)T.
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 Steil
Applicant Name /(/I
Address 1
City f�
Project Location (County,
i ype ana uimensions of rroject
Road, Water Body, etc.) _
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.
SKETCH e W P1
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.
€yet 2 2 14
mission
Phone Number C _:i 7 '7
State AJ G Zip .V ?t '
�.
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.
(SCALE: v. )
Hppncanus signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203