General Permits (3822)

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�CERTIFICATION OF EXEM h,17rr
_Y OCT U a 19, '
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, `j
Department of Environment, Health, and Natural Resources and the Co
in an area of environmental concern pursuant to 15 NCAC Subchapter
Applicant Name r tr;N Ee �_ (,�k�- Phone Number
Address
City tAtf (141N144 tint � State Zip
Project Location (County, State Road, Water Body, etc.) � T i=- ' • Lt,-t H 691 L&
Type and Diritensions of project mot€ Xt5 3�i�' PUi a
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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 c(-rtification 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.
I SKETCH Pr/,�:rdJr--W (SCALE: Sufi -N S-0.(A) I
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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.
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CAMA Official's signature
G 2" /,
issuing da
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203