General Permits (3794)

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CERTIFICATION OF EXE ! ION
FROM REQUIRING A CAMA PERMIT FF Ei c"37
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and t ast'af Resources Commission
in anareaof environmental concern pursuant to 11-5•-NCAC Subcha'�5t15'f`7K:.10203:
Applicant Name Ott t r� dJU tJ�A 1Dhn�c,r� Phone Number IU Du- 32a�j
Address P 0 IZO x Z "1 t
City T, :7 1 State ) L Zip C;?'q' q 4
Project Location (County, State Road, Water Body, etc.) (�>r. ��/` C_ a( 1 '. 2 C r
TpsA'� t 13: wck' -ToDse i l
Type and Dimensions of Project
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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 for g0 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: Iit : fir, )
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TetIA ce- the r, "t
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f,:..i,;: t.L AU
A n.. nnrcnn whn nrn antic with n rtcvcinnmcnt without tho nnn-
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.
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L% r i r ✓1.. Z= r .
,S9 v rre- fe4 O r
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Applicant's signature 101)
LAMA Q ici4l's signature
Issuing dale
Expiration date..
Attachment: 15 North Carolina Administrative Code 7K .0203