General Permits (3803)

Applicant Na Me(
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City
P. ojectr.LQcation
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CERTIFICATION OF E'MPTIQ N
FROM REQUIRING A CAMA PER CEC 1 2 1`9s� ii
as authorized by the State of North Carolina, Z, MMAj 2l,_`7U — 1--71.�
Department of Environment, Health, and Natural Re so Fees Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
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;ounState Road, Water Body, etc.)
C:iCKI t`f,� ,.
Type and Dimensions of Project
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.
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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 ('" .� r` c , t� (SCALE: )
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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.
Appf ant's sign tur (r�,
CAMA Official's ignature
11
Issuing date
-7f
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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