General Permits (3825)

Applicant Name
Address
City r M
Project Location
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CERTIFICATION OF E --
FROM REQUIRING A CAMA PERMI SEP 2 7 M3"u
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resourcd ission
in an area of environmental concern pursuant to 15 NCACSM"'MSl2t4M!e2eT.1B&`n- w
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ty, Stat Road, Ater Body, etc.) E'w � /V0 V f-fT t Oulu I-
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Type and Dimensions of Project �'X ��� ,���"�' >`- �.-� X / _2 7-
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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 7-K .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 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,' < (/ _ (,_ ) (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-wxitten-statement has been•obtafned*orn-adjacent
landowners---certifying--that--they--have-no-.-objections- to --the
proposed -work.
L le
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CAMA Official's signature
Issuing
Expiration /ate
Attachment: 15 North Carolina Administrative Code 7K .0203

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