General Permits (3812)

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Applicant Name
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City 1" 1 i,I i i 3
Pro' ct catio
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CERTIFICATION OF E!
FROM REQUIRING A CAMA PERM,
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resour
in an area of environmental concern pursuant to 15 NCA1
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Tyrpeiand Dimgnsions 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.
JAN 0 7 1997
mmission
Phone Number
State K_. Zip
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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.
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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 Applicant's signature +
development is exempted, will be in violation of the CAMA if there r
is a subsequent determination that a permit was required for the 1
development.
CAMA Official's si natur,
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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 Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K .0203

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