General Permits (3818)

CERTIFICATION OF Ets
A8.W.11
FROM REQUIRING A CAMA PERM1 5 19r'6
as authorized by the State of North Carolina,Department of Environment, Health, and Natural Resoura
in an area of environmental concern pursuant to 15 NCAC 010"W
Applicant Name Phone Number
Address".
City f-�---=- State
Project Location (County, State Road, Water Body, etc.) -
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.
mission
Zip
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.
Any person who proceeas wnn a oeveiopmem wirnour ine wn-
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
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
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:
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203