General Permits (3970)

CERTIFICATION OF EXE
FROM REQUIRING A CAMA PERMIT I NOV 2 0 WrS :R
as authorized by the State of North Carolina, �1
Department of Environment, Health, and Natural Resources an t ati sion
in an area of environmental concern pursuant to 15 NCAC Subc a� er
Applicant N�aMe 1,om Co - i 1c, tA ot r
Address F ou
City p,► , �Y1 i K- State . Zip' 3
Project Location (1G e tty, State F�oad, Water Body, etc.) ) ; CC'.�{. Y Vc. f .6 t t _1 - 1 {
l(6 i(vc—'r t, & r
Type and Dimensions of Project 1
,c.
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.
SKETCH i .� --41 '
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.
(SCALE: )
T
— 9
JAIL lifa (c -
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.
.0 r ( 1, __
�3 —
Ap{ lica s signature,
CAMA Official's sjgnatu e
1 f ! �-'
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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